Effects of malnutrition on outcomes of patients with femoral head osteonecrosis undergoing total hip arthroplasty: A population‐based study

Abstract

BackgroundThis study aimed to evaluate the impact of malnutrition on in‐hospital outcomes in patients undergoing total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH).MethodsThis population‐based retrospective study extracted data of patients undergoing THA for ONFH in the US National Inpatient Sample between 2005 and 2018. Factors associated with in‐hospital mortality, medical and surgical complications, unfavorable discharge, and prolonged hospital stay were determined by logistic regression analysis.ResultsA total of 72,304 adults ≥18 years old with nontraumatic ONFH admitted for primary THA were included. Malnutrition was detected in 7152 (9.9%) patients using validated discharge codes. In‐hospital mortality was 0.8% vs 0.1% for patients who were malnourished vs nonmalnourished. After adjusting for confounders, malnutrition was significantly associated with an increased risk of in‐hospital death (adjusted odds ratio [aOR], 4.67; 95% CI, 2.43–8.97), medical complications (aOR, 1.49; 95% CI, 1.32–1.68), surgical complications (aOR, 1.78; 95% CI, 1.61–1.96), unfavorable discharge (aOR, 1.24; 95% CI, 1.11–1.39), and prolonged hospital stay (aOR, 1.90; 95% CI, 1.67–2.16) compared with adequate nutrition. Malnutrition was also associated with higher total hospital costs (adjusted β = $9620; 95% CI, 7.87–11.36). Furthermore, the association between malnutrition, any medical or surgical complications, and unfavorable discharge was stronger in patients younger than 50 years than those ≥50 years old.ConclusionsIn US patients undergoing primary THA for ONFH, malnutrition increases the risk of unfavorable in‐hospital outcomes. This patient subgroup may require special attention and better strategies to improve perioperative care.