Malnutrition in Joint Arthroplasty: Prospective Study Indicates Risk of Unplanned ICU Admission

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, PA, USA

2 Department of Medicine, Penn Presbyterian Medical Center, Medical Arts Building, Philadelphia, PA, USA

3 Department of Orthopaedic Surgery, Penn Presbyterian Medical Center,Philadelphia, PA, USA

4 Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, Philadelphia, PA, USA

Abstract

 
 
Background: Malnutrition has been linked to poor outcomes after elective joint arthroplasty, but the risk of unplanned postoperative intensive care unit (ICU) admission in malnourished arthroplasty patients is unknown.
Methods: 1098 patients were followed as part of a prospective risk stratification program at a tertiary, high-volume arthroplasty center. Chronic malnutrition was defined as preoperative albumin
Results: The overall incidence of malnutrition was 16.9% (primary and revision arthroplasty patients). Average BMI was highest for patients in albumin category 3.0-3.5 (BMI 35.7). Preoperative albumin postoperative ICU admission.
Conclusion: Patients with poor nutritional status must be counseled on the risks of adverse medical complications.
 
 
 

Keywords

References

  1. Bistrian BR, Blackburn GL, Hallowell E, Heddle R. Protein status of general surgical patients. JAMA. 1974; 230(6):858-60.
  2. Hill GL, Blackett RL, Pickford I, Burkinshaw L, Young GA, Warren JV, et al. Malnutrition in surgical patients. An unrecognised problem. Lancet. 1977; 1(8013):689-92.
  3. Yu PJ, Cassiere HA, Dellis SL, Manetta F, Kohn N, Hartman AR. Impact of preoperative prealbumin on outcomes after cardiac surgery. JPEN J Parenter Enteral Nutr. 2015; 39(7):870-4.
  4. Deren ME, Huleatt J, Winkler MF, Rubin LE, Salzler MJ, Behrens SB. Assessment and treatment of malnutrition in orthopaedic surgery. JBJS Rev. 2014; 2(9):e1.
  5. Westvik TS, Krause LK, Pradhan S, Westvik HH, Maloney SP, Rutland R, et al. Malnutrition after vascular surgery: are patients with chronic renal failure at increased risk. Am J Surg. 2006; 192(5):e22-7.
  6. Mullen JL, Gertner MH, Buzby GP, Goodhart GL, Rosato EF. Implications of malnutrition in the surgical patient. Arch Surg. 1979; 114(2):121-5.
  7. Adogwa O, Martin JR, Huang K, Verla T, Fatemi P, Thompson P, et al. Preoperative serum albumin level as a predictor of postoperative complication after spine fusion. Spine (Phila Pa 1976). 2014: 39(18):1513-9.
  8. Ho JW, Wu AH, Lee MW, Lau SY, Lam PS, Lau WS, et al. Malnutrition risk predicts surgical outcomes in patients undergoing gastrointestinal operations: Results of a prospective study. Clin Nutr. 2015; 34(4):679-84.
  9. Nicholson JA, Dowrick AS, Liew SM. Nutritional status and short-term outcome of hip arthroplasty. J Orthop Surg (Hong Kong). 2012; 20(3):331-5.
  10. Lesourd B, Mazari L. Nutrition and immunity in the elderly. Proc Nutr Soc. 1999; 58(3):685-95.
  11. Jensen JE, Jensen TG, Smith TK, Johnston DA, Dudrick SJ. Nutrition in orthopaedic surgery. J Bone Joint Surg Am. 1982; 64(9):1263-72.
  12. Jaberi FM, Parvizi J, Haytmanek CT, Joshi A, Purtill J. Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty. Clin Orthop Relat Res. 2008; 466(6):1368-71.
  13. Cross MB, Yi PH, Thomas CF, Garcia J, Della Valle CJ. Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg. 2014; 22(3):193-9.
  14. Greene KA, Wilde AH, Stulberg BN. Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications. J Arthroplasty. 1991; 6(4):321-5.
  15. Dickhaut SC, DeLee JC, Page CP. Nutritional status: importance in predicting wound-healing after amputation. J Bone Joint Surg Am. 1984; 66(1):71-5.
  16. Yi PH, Frank RM, Vann E, Sonn KA, Moric M, Della Valle CJ. Is Potential malnutrition associated with septic failure and acute infection after revision total joint arthroplasty. Clin Orthop Relat Res. 2015; 473(1):175-82.
  17. Huang R, Greenky M, Kerr GJ, Austin MS, Parvizi J. The effect of malnutrition on patients undergoing elective joint arthroplasty. J Arthroplasty. 2013; 28(8 Suppl):21-24.
  18. Vanek VW. The use of serum albumin as a prognostic or nutritional marker and the pros and cons of IV albumin therapy. Nutr Clin Pract. 1998; 13(3):110-22.
  19. Fuhrman MP. The albumin-nutrition connection: separating myth from fact. Nutrition. 2002; 18(2):199-200.
  20. Seltzer MH, Bastidas JA, Cooper DM, Engler P, Slocum B, Fletcher HS. Instant nutritional assessment. JPEN J Parenter Enteral Nutr. 1979; 3(3):157-9.
  21. Patterson BM, Cornell CN, Carbone B, Levine B, Chapman D. Protein depletion and metabolic stress in elderly patients who have a fracture of the hip. J Bone Joint Surg Am. 1992; 74(2):251-60.
  22. Koval KJ, Maurer SG, Su ET, Aharonoff GB, Zuckerman JD. The effects of nutritional status on outcome after hip fracture. J Orthop Trauma. 1999; 13(3):164-9.
  23. Bourne R, Mukhi S, Zhu N, Keresteci M, Marin M. Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res. 2007; 465:185-8.
  24. Shenkin A, Cederblad G, Elia M, Isaksson B. Laboratory assessment of protein energy status. J Int Fed Clin Chem. 1996; 8(2):58-61.
  25. Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc. 2004; 104(8):1258-64.
  26. Seres DS. Surrogate nutrition markers, malnutrition, and adequacy of nutrition support. Nutr Clin Pract. 2005; 20(3):308-13
The Archives of Bone and Joint Surgery
Volume 4, Issue 2 - Serial Number 2
April 2016
Pages 128-131

Files

History

  • Receive Date: 24 August 2015
  • Revise Date: 09 October 2015
  • Accept Date: 08 October 2015

Share

How to cite

Statistics