Abstract
BackgroundMalnutrition is a common and modifiable risk factor for postoperative complications and adverse outcomes in orthopedics. The purpose of this study was to identify biomarkers of malnutrition in patients undergoing elective total knee arthroplasty (TKA) that are predictive of adverse in-hospital postoperative complications, to facilitate the identification of at-risk patients for nutritional optimization before surgery.MethodsA total of 624 patients who underwent elective TKA between 2013 and 2017 were evaluated; potential biomarkers of preoperative malnutrition, including hypoalbuminemia (serum albumin < 3.5 g/dL), total lymphocyte count (TLC < 1500 cells/mm3), and body mass index (BMI), were assessed for any association with in-hospital postoperative complications.ResultsThe prevalence of hypoalbuminemia, low TLC, overweight, obesity class I, and obesity class II were, respectively 2.72%, 33.4%, 14.8%, 44.5%, and 26.9%. There was a significant association between hypoalbuminemia and obesity class II (BMI ≥ 30.0 kg/m2) with rates of peri-prosthetic joint infection, and no significant association between such complications and low TLC, overweight, or obesity class I. Logistic regression analysis showed that patients with hypoalbuminemia or being in obesity class II with gouty arthritis were more likely to suffer from peri-prosthetic joint infection.ConclusionsHypoalbuminemia and obesity class II together is a reliable biomarker of preoperative malnutrition for predicting peri-prosthetic joint infection after elective TKA, whereas low TLC, overweight, and obesity class I were not significantly associated with an increased risk of such complications.
Highlights
Malnutrition is a common and modifiable risk factor for postoperative complications and adverse outcomes in orthopedics
A total of 433 patients with available preoperative body mass index (BMI) were analyzed (68.8% of the cases reviewed). They were categorized into five groups – normal weight, underweight (BMI < 18.5 kg/m2), overweight (BMI 23.0–24.9 kg/m2), obesity I (BMI 25.0–29.9 kg/m2), and obesity II (BMI ≥ 30.0 kg/m2); the respective prevalence of each of the groups were 12.5%, 1.2%, 14.8%, 44.5%, and 26.9%
There were studies in Asia [23–26] that looked into the association between obesity and various post-total knee arthroplasty (TKA) outcomes, and a large-scale Korean study [27] on malnutrition and post-TKA wound complications, none provided a comprehensive evaluation of the relationship between malnutrition and postoperative complications; as the first of such analyses in the Asia-Pacific region, this study provided new insights into this topic
Summary
Malnutrition is a common and modifiable risk factor for postoperative complications and adverse outcomes in orthopedics. The purpose of this study was to identify biomarkers of malnutrition in patients undergoing elective total knee arthroplasty (TKA) that are predictive of adverse in-hospital postoperative complications, to facilitate the identification of at-risk patients for nutritional optimization before surgery. Malnutrition has long been linked to postoperative complications and adverse outcomes in a variety of surgical fields [1], such as increased susceptibility to infection [2, 3], delayed wound healing [4, 5], and an increased frequency of decubitus ulcers. It is a modifiable risk factor, as evidenced by studies that have associated optimization of preoperative nutrition with improved surgical outcomes [6, 7]. It is crucial to identify sensitive markers that can be utilized to screen for clinical as well as subclinical malnutrition patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
