The malnourished consult: A quiet prevalence in complex musculoskeletal patients

Abstract

Malnutrition is associated with major perioperative complications including delayed wound healing and dehiscence following orthopedic procedures. This study will review all arthroplasty and elective spinal fusion patients with complications requiring a plastic surgery consultation. We seek to elucidate patient risk factors predisposing this population to wound complications. A retrospective chart review at a single academic center was performed on a series of knee arthroplasty, hip arthroplasty, and spinal fusion patients with a documented plastic surgery consultation between January 1, 2001 and October 22, 2021. Patient demographics, time to consultation, nutritional laboratory studies, comorbidities, and complications were all considered. Statistical analysis included t-tests, chi-square analysis, and multivariate logistic regression models. Ninety patients met inclusion criteria. Fifty-three patients (58.8%) qualified as malnourished according to an albumin of <3.5 g/dL or prealbumin of <15 mg/dL. Only 70% (n=63) of patients had nutritional work-up and 36% (n=33) had documented consultation with a nutritionist. All but 6 patients (6.7%) suffered complications with a mean of at least 3 (+/- 1.59) complications per patient. Wound infections and breakdown were especially common: 18 patients (20.0%) developed wound infections, 30 patients (33.3%) developed wound dehiscence, 26 patients (28.9%) developed a combination of wound infection and breakdown, and only 16 patients (17.8%) had no wound-related complications. Optimizing patient risk factors and interdisciplinary cooperation are crucial prior to high-risk surgeries such as knee arthroplasties, hip arthroplasties, and spinal fusions. These patients often necessitate early plastic surgery and nutrition involvement to mitigate morbidity and improve surgical outcomes. • Nutritional workup is inconsistently accomplished and without standardization. • Not all patients with malnutrition receive nutrition consults and interventions. • Patients with malnutrition experience more revisional operations. • Care of this patient population necessitates an interdisciplinary team.