Geriatric nutrition index is independent predictor of adverse TJA outcomes
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The Geriatric Nutritional Risk Index predicted adverse outcomes and the need for transfusions when applied to patients older than 65 years in a national database who underwent total joint arthroplasty, results showed.
At the American Association of Hip and Knee Surgeons Annual Meeting, Christopher J. Fang, MD, a research fellow at New England Baptist Hospital, said he and his colleagues studied nutritional status in patients undergoing TJA because malnutrition negatively affects their outcomes.
“There is no unanimous method for screening and assessing malnutrition. The Geriatric Nutritional Risk Index or GNRI has been proposed as a method for screening for malnutrition,” he said.
The GNRI is calculated using a formula that includes the BMI, sex, height and weight of a patient.
From their application of the GNRI to the 191,087 patients in the American College of Surgeons National Surgical Quality Improvement Program database from 2016 to 2019 who were aged older than 65 years and underwent TJA, researchers found a 15.83% prevalence of malnutrition based on GNRI less than 98 or about 30,000 patients affected.
Definitions used were normal nutrition with GNRI greater than 98; moderate malnutrition with GNRI of 92 to 98; and severe malnutrition with GNRI less than 92.
By comparison, in the same patients, the malnutrition rate based on BMI less than 18.5 kg/m2 alone was 0.41% and based on albumin levels of less than 3.5 mg/dL alone was 4.17%, results showed.
“Adjusted analysis showed that compared to normal nutrition, both moderate and severe malnutrition were associated with a higher rate of transfusion, readmission and a postoperative length of stay [LOS] over 8 days,” Fang said.
Severe malnutrition based on GNRI was “also associated with pneumonia, surgical site infection, urinary tract infection, sepsis and revision surgery,” he said.
“Malnutrition as defined by GNRI is an independent predictor of transfusion, readmission and extended LOS for patients undergoing TJA,” Fang said.
He said the index has been validated in assessing nutritional status and in predicting morbidity and mortality in patients in other specialties, such as general surgery.
Editor’s Note: On Nov. 18, 2021, the article was updated to add a malnutrition rate of 4.17% corresponding to albumin levels of less than 3.5 mg/dL alone.
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Fang CJ, et al. Paper 48. Presented at: American Association of Hip and Knee Surgeons Annual Meeting. Nov. 11-14, 2021; Dallas (hybrid meeting).
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