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Preoperative hypoalbuminemia may be predictive of infection, pneumonia after TJA

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ORLANDO, Fla. — Malnutrition is an independent risk factor for surgical site infection, pneumonia, complications, length of stay and readmission after total joint arthroplasty, according to data presented at the American Academy of Orthopaedic Surgeon Annual Meeting.

“We propose randomized trials testing for the efficacy of preoperative nutritional interventions for patients who are malnourished. If successful, we believe these data and other data in the literature suggest that such outcomes could have major impact on short-term outcomes, Daniel D. Bohl, MD, MPH, said.

To study the association between preoperative hypoalbuminemia, which is a marker for malnutrition, and complications, Bohl and colleagues compared outcomes that occurred during the first 30 postoperative days after elective primary total hip arthroplasty and total knee arthroplasty. They identified 49,603 patients who had preoperative serum albumin concentration recorded as part of the American College of Surgeons National Surgical Quality Improvement Program. Hypoalbuminemia was defined as serum albumin concentration less than 3.5 g/dL and its prevalence in the patient population was 4%.

In comparison to patients with normal albumin concentrations, Bohl and colleagues found that patients with hypoalbuminemia had a higher risk for surgical site infection compared with patients with normal albumin concentrations. Patients with hypoalbuminemia also had a higher risk of pneumonia, occurrence of complications and occurrence of a serious complications when compared to patients with normal albumin concentrations.

Mean postoperative length of stay was longer for patients with hypoalbuminemia at 3.52 days compared to the 3.10 days for patients with normal albumin concentrations. Additionally, patients with hypoalbuminemia had a higher rate of hospital readmission compared to patients without hypoalbuminemia. – by Kristine Houck, ELS

Reference:

Bohl DD, et al. Paper #166. Presented at: American Academy of Orthopaedic Surgeon Annual Meeting; March 1-5, 2016; Orlando, Fla.

Disclosure: Bohl reports no relevant financial disclosures.