Effective nutritional status screening in orthopaedic oncology patients and post-operative complications

Abstract

This study aims to determine the prevalence of malnutrition among orthopaedic oncology patients with malignant tumour during preoperative period. Methods: This is a prospective observational study involving patients from the orthopaedic oncology unit who were undergoing surgery. They were assessed with Patient Generated Subjective Global Assessment (PG-SGA), Malnutrition Screening Tool (MST) and 3-minute Nutritional Screening (3MinNS) questionnaires. Anthropometric data such as body mass index, mid upper arm circumference (MUAC) and blood parameters such as serum albumin, total lymphocyte count and haemoglobin were also investigated. Patients were then followed up for 3 months. Post-operative complications were divided into infectious and non-infectious groups. Length of stay and unplanned readmission were also documented. Results: Prevalence of malnutrition ranged from 13.3% to 45.8% under different nutritional assessment methods. Patients who were determined as malnourished were significantly associated with both infectious and non-infectious post-operative complications (p < 0.001). PG-SGA and 3MinNS values were also significant in univariate and multivariate analysis, respectively. Low serum albumin (<35 g/L) was associated with post-operative infectious complications, especially surgical site infection (p < 0.001), prolonged hospital stay (p ¼ 0.009) and unplanned readmission (p ¼ 0.017). 3MinNS and Charlson Comorbidity Index were predictive of non-infectious complications, whereas serum albumin and the presence of metastasis were predictive of infectious complications. Conclusion: This pilot study of patients with soft tissue and bone sarcoma of upper and lower limbs showed that malnutrition is a significant independent factor related to infectious and non-infectious complications which leads to unplanned readmission and prolonged length of stay. Periodic screening using the PG-SGA or 3MinNS questionnaires, MUAC and evaluation of serum albumin levels is recommended during clinic session and pre-surgery assessment rounds to identify those predisposed to malnutrition and help in reducing incidence of post-operative complications.

Effects of Seamless Operating Room Nursing Combined with Multistyle Health Education on the Psychological State, Rehabilitation Quality, and Nursing Satisfaction in Patients with Internal Fixation of Femoral Fracture

“…The Profile of Mood States (POMS)[ 12 ] questionnaire was adopted to assess the patients' mood states after nursing. This profile included 7 dimensions of fatigue, vigor, tension, confusion, and so on, with 40 items in total.…”

Lymphopenia predicts 30-day morbidity and mortality following spinal metastasis surgery

“…Patients with spinal metastasis are usually weakened, but their clinical presentation varies widely [1] . TLC is a simple tool that can be used to estimate the patient's ability to recover from a major surgery, as it indicates how prepared the patient is to endure a postoperative intensive care unit (ICU) stay without developing pneumonia [5] or other life-threatening infectious or non-infectious complications [18] .…”

“…Because malnutrition is a common finding in orthopedic oncology and its role in unfavorable surgical outcomes is well known [18] , preoperative screening with TLC measurement has been suggested. Zinc and other vitamins act on cell maturation, and vitamin deficiency may partially explain the presence of lymphopenia in severely malnourished patients [20] .…”

“…TLC and serum albumin are traditional nutritional markers that can be used clinically, either alone or via PNI using the following equation: PNI = (10 x albumin g/dL) + (0.005 x TLC µg/dL). The clinical value of serum albumin alone has been widely studied, and its predictive power for the occurrence of orthopedic complications has been established at levels < 3.5 mg/dL [ 18 , 21 ]. No cut-off point has been determined for TLC regarding the prediction of clinical outcomes.…”

Investigating readmission rates for patients undergoing oncologic resection and endoprosthetic reconstruction for primary sarcomas and tumors involving bone

“…[4][5][6][7][8][9][10] Unfortunately, Orthopaedic oncology patients represent a distinct Orthopaedic patient population that are particularly susceptible to poor surgical outcomes and an increased risk for hospital readmission. [11][12][13] While the rate of readmissions across all subgroups for nononcologic Orthopedic surgeries ranges from 1% to 3.5%, [14][15][16] Orthopaedic oncology patients with a sarcoma of the extremities may experience a readmission rate ranging from 8.0% to 18.0% after surgery. 16,17 While it is clear that Orthopaedic oncology patients are at an increased risk for readmission, it is still not clear why this disparity exists.…”