A retrospective study.To compare the mini nutritional assessment-short form (MNA-SF), geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI) and preoperative serum albumin level as predictors of postoperative adverse events (AEs) in degenerative spine deformity (DSD) patients.Although various nutritional screening tools have been well evaluated in patients undergoing spinal fusion surgery, the most suitable tool for the DSD population remains uncertain at present.We reviewed consecutive patients who underwent thoracolumbar fusion surgery for DSD between August 2016 and May 2023. Four screening tools were used to assess preoperative nutritional status. Patients were divided into two categories according to each screening tool and the four screening tools were compared regarding the predictive power for postoperative AEs including the rates of extended LOS, complications and readmission within 3 months. Physical functional indicators such as time to first ambulation, non-home discharge and postoperative LOS were assessed as secondary outcome measures. Multivariable logistic regression analysis was used to identify factors associated with postoperative AEs.A total of 228 patients were included. The demographic characteristics, underlying disease, and magnitude of correction were not significantly different between well-nourished and malnourished groups. The nutritional risks shown by MNA-SF and albumin level were significantly associated with infectious complications (P<0.05). The nutritional risk shown by MNA-SF was significantly associated with non-home discharge, prolonged postoperative LOS (12.5±8.2 vs. 10.3±6.1, P=0.039) and delayed ambulation (3.7±2.1 vs. 2.2±1.8, P=0.001). Multivariable logistic regression revealed that PNI<50 was significantly associated with total AEs and minor AEs after DSD surgery.PNI was significantly associated with the incidence of total AEs and minor AEs, while preoperative albumin level and MNA-SF were more effective in predicting postoperative infectious complications and delayed recovery of physical function, respectively.III.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.