Staircase Nutritional Intervention for Elderly Patients Undergoing Spinal Fusion Surgery

Comprehensive Complication Index (CCI)

The primary outcome is the Comprehensive Complication Index (CCI), a continuous scale (0-100 points, where 100 indicates death due to complications) that integrates all complications and their severity based on the Clavien-Dindo classification system. Postoperative complications will be recorded up to 90 days post-surgery (definitions in Appendix 1), with severity scored using the Clavien-Dindo system. CCI will be calculated using an online calculator (http://www.assessurgery.com). Previous studies have validated CCI as an effective measure of postoperative morbidity, demonstrating greater comprehensiveness and sensitivity than traditional metrics (e.g., overall complication rate or severe complication rate) for surgical research endpoints.

Pain level

The Visual Analogue Scale (VAS) is a widely used tool to measure pain intensity. It consists of a 10-centimeter horizontal line, with endpoints labeled "no pain" (0) and "worst possible pain" (10). During the assessment, patients are asked to mark a point on the line that corresponds to their current pain level. This simple yet effective method provides a quantitative measure of pain, allowing for consistent monitoring and comparison of pain intensity over time.

Physiological function recovery

Sum of days to first defecation, first urination, and first ambulation postoperatively.

Serum Albumin Levels Measured Postoperatively

Serum albumin is a protein produced by the liver and is an important marker of nutritional status and overall health. To measure serum albumin levels, a blood sample is drawn and analyzed in a clinical laboratory using techniques such as spectrophotometry. Normal serum albumin levels typically range from 3.5 to 5.0 grams per deciliter (g/dL). In the postoperative period, monitoring serum albumin helps assess a patient's recovery, as low levels may indicate poor nutrition, inflammation, or other complications that can delay healing.

Health-related quality of life

Evaluated using the EuroQol five-dimension scale (EQ-5D, 0 = poorest health, 100 = best health).

Long-term follow-up of Postoperative Pain Level Measured by Visual Analogue Scale (VAS)

The pain level is evaluated using the Visual Analogue Scale (VAS), a 10-centimeter horizontal line with endpoints labeled "no pain" (0) and "worst possible pain" (10). Patients mark a point corresponding to their current pain intensity at follow-up visits, quantifying pain to monitor changes over time.

Long-term follow-up of functional disability assessment using Oswestry/NDI Index

Functional disability is assessed with the Oswestry Disability Index (ODI) for lumbar patients and Neck Disability Index (NDI) for cervical patients. Self-report questionnaires include daily activities (e.g., personal care, walking), rated 0 (no disability) to 5 (complete disability). Total scores (as percentages) reflect disability severity and treatment impact.

Long-term follow-up of ADL and IADL scales assessment of activities of daily living

ADL (basic self-care: eating, dressing) and IADL (complex skills: shopping, finance) scales evaluate independent living abilities. Scores at follow-up visits determine recovery and surgical impact on daily function.

Long-term follow-up of quality of life evaluation by EQ-5D score

The EQ-5D scale assesses mobility, self-care, pain, and mental state (5 dimensions, each 0-3 severity levels). A visual analog health rating (0-100) is integrated to generate scores, with higher values indicating better quality of life.