Albumin, Prealbumin, and Transferrin May Be Predictive of Wound Complications following Total Knee Arthroplasty

Abstract

Nutritional status has become increasingly important in optimizing surgical outcomes and preventing postoperative infection and wound complications. However, currently, there is a paucity in the orthopaedics literature investigating the relationship between nutritional status and wound complications following total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine the prevalence of (1) postoperative infections, (2) wound complications, (3) concomitant infection with wound (CoIW) complication, and (4) infection followed by wound complication by using (1) albumin, (2) prealbumin, and (3) transferrin levels as indicators of nutritional status. These four different outcome measures were chosen as they are encountered commonly in daily clinical practice. A retrospective review of a national private payer database for patients who underwent TKA with postoperative infections and wound complications stratified by preoperative serum albumin (normal: 3.5–5 g/dL), prealbumin (normal: 16–35 mg/dL), and transferrin levels (normal: 200–360 mg/dL) between 2007 and 2015 was conducted. Patients were identified by Current Procedural Terminology (CPT), International Classification of Disease, ninth revision (ICD-9) codes, and Logical Observation Identifiers Names and Codes (LOINC). Linear regression was performed to evaluate changes over times. Yearly rates of infection, as well as a correlation and odds ratio analysis of nutritional laboratory values to postoperative complications, were also performed. Our query returned a total of 161,625 TKAs, of which 11,047 (7%) had postoperative wound complications, 18,403 (11%) had infections, 6,296 (34%) had CoIW, and 4,877 (4%) patients with infection developed wound complications. Albumin was the most commonly ordered laboratory test when assessing complications (96%). Wound complications, infections, CoIW, and infection with wound complications after were higher in those below the normal range: albumin <3.5 g/dL (9, 14, 6, and 5%), prealbumin <15 mg/dL (20, 23, 13, and 12%), and transferrin <200 mg/dL (12, 17, 6, and 6%). Preoperative albumin, prealbumin, and transferrin values falling below the normal range represented an increased risk for postoperative complications. Those patients who were in the normal range, however, did not have an increased risk. Therefore, our results suggest that preoperative nutritional optimization can play an important role in reducing the risk for postoperative complications.

Low preoperative prealbumin predicts the prevalence of complications following liver transplantation

“…Numerous studies have incorporated prealbumin into preoperative nutritional assessments and have used it for surgical risk stratification [ 9 , 10 ] As for hepatopancreatobiliary diseases, preoperative prealbumin plays a crucial role in predicting postoperative complications, such as for patients undergoing pancreaticoduodenectomy or hepatectomy [ 11 – 13 ]. This relationship was also demonstrated in patients undergoing total knee arthroplasty and kidney transplantation [ 14 , 15 ]. Moreover, preoperative prealbumin combined with disease severity has been reported to yield better predictions in patients with liver cirrhosis [ 16 ].…”

Malnutrition in Orthopaedic Sports Medicine: A Review of the Current Literature

“…Using these measurements, malnutrition was first described as a risk for poor postoperative outcomes in hip fracture patients, where it was demonstrated that malnourished patients suffered increased complications and longer rehabilitation times. 57 These findings were recapitulated in the elective setting, as malnutrition was shown to independently increase hospital costs, morbidity, and mortality in the spine 2,13 and total joint arthroplasty 12,43,65 literature. Similarly, micronutrient deficiencies, including low serum levels of vitamin D, iron, and other minerals (zinc, magnesium, folate, and copper, among others) have been linked to poor outcomes after these elective orthopaedic procedures 27,41,55,83…”

“…Serum albumin levels are widely accepted in the orthopaedic literature as an important indicator of overall macronutrient status, and hypoalbuminemia is regularly used to identify malnutrition and investigate its association with postoperative outcomes. Using a definition of serum albumin <3.5 g/dL, malnutrition has consistently been described in studies as a risk factor associated with postoperative complications in various areas of orthopaedics, such as total joint arthroplasty 12,63,65 and spine surgery. 2,13 Though well-described in these orthopaedic subspecialties, little data exist on the clinical implications of macronutrient deficiencies in orthopaedic sports medicine outcomes, such as bone-tendon interface healing; muscle, tendon, and ligament healing; and outcomes after orthopaedic sports medicine procedures (O. Jalali, BS, et al, unpublished data, 2019).…”

“…These include serologic laboratory values and standardized scoring methods, as well as anthropometric measurements that describe nutritional status on a macronutrient scale. 19,49,57,65 Frequently used standards for serologic laboratory values include total lymphocyte count <1500 cells/mm 3 , serum albumin <3.5 g/dL, and serum transferrin <200 mg/dL. 57,65…”

Prealbumin May Predict Clinical Outcomes in Children with Severe Mycoplasma pneumoniae Pneumonia

“…A crosssectional study of 867 patients with acute coronary syndrome showed that PA was negatively and independently associated with angiographic severity, indicating its potential as a biomarker for estimating the burden of coronary atherosclerosis (12). Roche et al also reported that patients with preoperative PA values below the normal reference range had an increased risk of postoperative wound complications following total knee arthroplasty (13). However, to the best of our knowledge, there has been little research focusing on PA levels in children with severe MPP.…”