Abstract
BACKGROUND: Malnutrition can lead to an increased risk of blood transfusion in elderly patients. The Geriatric Nutritional Risk Index (GNRI) is a tool used to assess nutritional status, but its predictive value for blood transfusion in elderly patients undergoing posterior lumbar interbody fusion (PLIF) is not well established. This study aimed to investigate the association between GNRI and the risk of perioperative blood transfusion in this population. METHODS: A retrospective cohort study was conducted on elderly patients aged 60 and above who underwent PLIF at Qingdao University Affiliated Hospital. Preoperative GNRI was calculated using height, weight, and serum albumin levels. The primary outcome was perioperative blood transfusion. Logistic regression analysis was performed, adjusting for potential confounders such as demographic characteristics, comorbidities, surgical factors, and laboratory tests. RESULTS: A total of 1,246 elderly patients were included, with 144 (11.6%) requiring blood transfusion. After adjusting for all confounders, a lower GNRI was associated with a significantly higher risk of blood transfusion (OR = 2.4, 95% CI: 1.9-3.1, p < 0.001). Patients with a GNRI score below 92 had a significantly increased transfusion risk compared to those with normal GNRI scores (OR = 5.8, 95% CI: 3.7-9.1, p < 0.05). RCS analysis revealed a linear negative relationship between GNRI and transfusion risk. CONCLUSION: The GNRI is a strong predictor of perioperative blood transfusion risk in elderly patients undergoing PLIF. Preoperative nutritional assessment using GNRI may help identify high-risk patients, enabling tailored interventions to optimize outcomes.