Hypoalbuminemia Independently Predicts Surgical Site Infection, Pneumonia, Length of Stay, and Readmission After Total Joint Arthroplasty

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Abstract

This study investigates the association between preoperative hypoalbuminemia, a marker for malnutrition, and complications during the 30 days after total joint arthroplasty. Patients who underwent elective primary total hip and knee arthroplasty as part of the American College of Surgeons National Surgical Quality Improvement Program were identified. Outcomes were compared between patients with and without hypoalbuminemia (serum albumin concentration < 3.5 g/dL) with adjustment for patient and procedural factors. A total of 49 603 patients were included. In comparison to patients with normal albumin concentration, patients with hypoalbuminemia had a higher risk for surgical site infection, pneumonia, extended length of stay, and readmission. Future efforts should investigate methods of correcting nutritional deficiencies prior to total joint arthroplasty. If successful, such efforts could lead to improvements in short-term outcomes for patients.

Section snippets

Methods

A retrospective analysis of prospectively collected data was conducted. Patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) were identified as part of the ACS-NSQIP in 2011 to 2013. Patients were identified using primary Current Procedural Terminology codes 27130 for primary THA and 27447 for primary TKA. The additional associated Current Procedural Terminology code fields and International Classification of Disease, Ninth Revision diagnosis code field

Results

A total of 101 523 patients were initially identified, of whom 49 603 (48.9%) had preoperative serum albumin laboratory values available for analysis. These 49 603 patients constituted the study population. Of these patients, 19 975 (40.3%) underwent primary THA and 29 628 (59.7%) underwent primary TKA.

The prevalence of hypoalbuminemia was 4.0% (95% confidence interval [CI], 3.8%-4.1%; Fig. 1). In the multivariate analysis (Table), hypoalbuminemia was independently associated with age strata (P <

Discussion

Prior studies have linked malnutrition to delayed wound healing and SSI after TJA 9., 10., 11., 12., 13., 14., 15., 16., 17., 18.. However, few studies have investigated the association between malnutrition and other postoperative complications [11]. Consistent with the literature, the present study finds that hypoalbuminemia, a marker for malnutrition, is independently associated with a 2-fold increase in the rate of SSI. The present study also demonstrates independent associations between

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements, refer to http://dx.doi.org/10.1016/j.arth.2015.08.028

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