Is Potential Malnutrition Associated With Septic Failure and Acute Infection After Revision Total Joint Arthroplasty?

Yi, Paul H.; Frank, Rachel M.; Vann, Elliott; Sonn, Kevin A.; Moric, Mario; Valle, Craig J. Della

doi:10.1007/s11999-014-3685-8

Cited by 104 publications

(73 citation statements)

References 32 publications

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“…Other complications associated with malnutrition in patients undergoing orthopaedic surgery include postoperative hematoma formation, and renal, cardiovascular, and neurovascular complications [7]. Results of our study are consistent with those of other studies showing an association between low serum albumin and an increase in multiple major perioperative complications [5,12,27,32] To our knowledge, our study is the largest to date evaluating the independent association between low serum albumin and perioperative complications after TKA. We focused specifically on elective primary TKAs and provide a detailed analysis of specific complications which are increased in patients with low serum albumin.…”

Section: Discussionsupporting

confidence: 89%

“…Malnutrition has been linked to persistent wound drainage, failure of wound healing, and surgical site infections after joint arthroplasty [5,9,11,15]. Deep periprosthetic infections (acute and chronic) also have been reported at a higher rate in patients with malnutrition [32]. Some studies have concluded that patients with malnutrition had a longer postoperative length of stay [12,27].…”

Section: Discussionmentioning

confidence: 99%

“…Benefits of TKA in populations at greater risk for complications are less well defined. Morbid obesity and malnutrition have been shown to be associated with increased perioperative complications after TKA [5,6,10,12,16,18,19,27,32]; however, some studies have not shown an increased risk of perioperative complications in patients who are morbidly obese [3,13,14,23,25]. In addition, patients with morbid obesity are more likely to be malnourished than patients who are not obese, raising the question whether morbid obesity, malnutrition, or both, are independently associated with increased perioperative complications [12].…”

Section: Introductionmentioning

confidence: 99%

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Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Nelson

Elkassabany

Kamath

et al. 2015

Clin Orthop Relat Res

134

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Background Morbid obesity and malnutrition are thought to be associated with more frequent perioperative complications after TKA. However, morbid obesity and malnutrition often are co-occurring conditions. Therefore it is important to understand whether morbid obesity, malnutrition, or both are independently associated with more frequent perioperative complications. In addition, assessing the magnitude of an increase in complications and whether these complications are major or minor is important for both conditions. Questions/purposes We asked: (1) Is morbid obesity independently associated with more frequent major perioperative complications after TKA? (2) Are major perioperative complications after TKA more prevalent among patients with a low serum albumin? Methods The National Surgical Quality Improvement Program (NSQIP) database was analyzed from 2006 to 2013. Patients were grouped as morbidly obese (BMI C 40 kg/m 2 ) or nonmorbidly obese (BMI C 18.5 kg/m 2 to \ 40 kg/m 2 ), or by low serum albumin (serum albumin level \ 3.5 mg/dL) or normal serum albumin (serum albumin level C 3.5 mg/dL). The study cohort included 77,785 patients, including 35,573 patients with a serum albumin level of 3.5 g/dL or greater and 1570 patients with a serum albumin level less than 3.5 g/dL. Therefore, serum albumin levels were available for only 37,173 of the 77,785 of the patients (48%). There were 66,382 patients with a BMI between 18.5 kg/m 2 and 40 kg/m 2 and 11,403 patients with a BMI greater than 40 kg/m 2 . Data were recorded on patient mortality along with 21 complications reported in the NSQIP. We also developed three composite complication variables to represent risk of any infections, cardiac or pulmonary complications, and any major complications. For each complication, multivariate logistic regression analysis was performed. Independent variables included patient age, sex, race, BMI, American Society of Anesthesiologists classification, year of surgery, and Charlson comorbidity index score. Results Mortality was not increased in the morbidly obese group (0.14% vs 0.14%; p = 0.942). Patients who were morbidly obese were more likely to have progressive renal insufficiency (0.30% vs 0.10%; odds ratio [OR], 2.47; 95% CI, 1.27-4.29; p \ 0.001), superficial infection (1.07% vs 0.55%; OR, 1.87; 95% CI, 1.39-2.51; p \ 0.001), and sepsis (0.36% vs 0.23%; OR, 1.70; 95% CI, 1.04-2.53; p = 0.034) compared with patients who were not morbidly obese. Patients who were morbidly obese were less likely to require blood transfusion (8.68% vs One of the authors certifies that he (CLN), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Zimmer Inc (Warsaw, IN, USA 12.06%; OR, 0.70; 95% CI, 0.63-0.77; p \ 0.001) compared with patients who were not morbidly obese. Morbid obesity was not associated with any of the other 21 perioperative complications recorded in the NSQIP database. With respect to the composite complication variable...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Nelson

Elkassabany

Kamath

et al. 2015

Clin Orthop Relat Res

134

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“…This sample size is likely underpowered to detect more predictors of PJI. This does, however, raise the concern that there may exist some underlying predisposition to infection in this cohort that may not be readily detected that may include subclinical immune deficiencies or malnutrition [10].…”

Section: Discussionmentioning

confidence: 86%

“…Patients with a history of PJI had a greater risk of developing PJI in a subsequent THA or TKA (10 Table 2). …”

Section: Resultsmentioning

confidence: 99%

A History of Treated Periprosthetic Joint Infection Increases the Risk of Subsequent Different Site Infection

Bedair

Goyal²,

Dietz

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background After the successful treatment of periprosthetic joint infection (PJI), patients may present with degenerative joint disease in another joint with symptoms severe enough to warrant arthroplasty. However, it is not known whether patients with a history of treated PJI at one site will have an increased risk of PJI in the second arthroplasty site.Questions/purposes The primary objective of this study is to determine if there is a difference in the risk of developing a PJI after a second total hip arthroplasty (THA) or total knee arthroplasty (TKA) in patients who have had a previous PJI at another anatomic site compared with patients who have had no history of PJI. The secondary objective is to determine other potential risk factors that may predict PJI at the site of the second arthroplasty. Methods A retrospective matched cohort study was performed to identify all patients at four academic institutions successfully treated for PJI who subsequently underwent a second primary THA or TKA (n = 90), constituting our study group. Patients were matched (one-to-one) to control subjects who had no history of PJI after their first arthroplasty (n = 90); they were matched based on age, sex, diabetic status, BMI, American Society of Anesthesiologists, institution, joint of interest, and year of surgery (± 2 years). We compared the case and control groups to determine whether a prior infection increased the relative risk of a subsequent PJI at another anatomic site. To identify other potential risk factors for subsequent PJI, a subgroup univariate analysis of our study group (n = 90) Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Is malnutrition associated with postoperative complications in patients with primary bone sarcomas?

Park

Lans

Raskin

et al. 2018

Journal of Surgical Oncology

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Background Modifiable risk factors that can be optimized to minimize postoperative complications in patients with bone sarcomas are yet to be identified. Methods We retrospectively identified 275 patients aged 18 and older who underwent surgery for primary bone sarcomas who also had albumin values recorded within 4 weeks before surgery. Postoperative complications were defined as infection, hematoma, need for additional surgery, or wound complications. Results In the multivariate analysis, age (P = 0.049) and neoadjuvant radiotherapy (P = 0.008) were independently associated with postoperative complications. We then performed a subanalysis of patients without a pelvic tumor who also did not receive radiotherapy (n = 178). In this population, albumin less than 2.8 g/dL was found to be independently associated with postoperative complications (odds ratio [OR], 4.69. 95% confidence intervals [CI], 1.03‐21.97; P = 0.046). Conclusions This study demonstrates that hypoalbuminemia (albumin < 2.8 g/dL) is associated with postoperative complications in patients with nonpelvic bone sarcomas who do not receive radiation. Future studies are necessary to further elucidate the role of nutrition, and they may show that nutritional status is a modifiable risk factor that can be optimized to improve the outcome of surgery for primary bone sarcomas.

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Is Potential Malnutrition Associated With Septic Failure and Acute Infection After Revision Total Joint Arthroplasty?

Abstract: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 104 publications

References 32 publications

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

A History of Treated Periprosthetic Joint Infection Increases the Risk of Subsequent Different Site Infection

Is malnutrition associated with postoperative complications in patients with primary bone sarcomas?

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