Low Albumin Is a Risk Factor for Complications after Revision Total Knee Arthroplasty

Abstract

Low serum albumin has been shown in the primary joint arthroplasty setting to increase the rate of perioperative complications. Our present work examined a large national inpatient administrative dataset to study the relationship between serum albumin level and key outcome measures after revision total knee arthroplasty (RTKA). Our hypothesis was that lower serum albumin would be an independent risk factor for poor outcomes after RTKA. We analyzed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2014, specifically evaluating patients undergoing RTKA. Patients were grouped as having hypoalbuminemia (serum albumin < 3.5 mg/dL) or normal albumin (serum albumin ≥ 3.5). We analyzed data on 22 complications as reported in the NSQIP database and developed composite complication variables (any infections, cardiac/pulmonary complications, and any major complications). For each complication, multivariable logistic regression analysis was used to evaluate its association. The cohort included 4,551 patients undergoing RTKA. Patients in the low serum albumin group were statistically more likely to develop deep surgical site infection, organ space surgical site infection, pneumonia, urinary traction infection, and sepsis. The hypoalbuminemic group was more likely to require unplanned intubation, blood transfusion intraoperatively or postoperatively, remain on a ventilator > 48 hours, and develop acute renal failure. There was also a higher risk of mortality and coma. Across the three composite complication variables, any complication (with or without transfusion), any major complication, and any infection (systemic, wound) were more prevalent among the patients with low serum albumin. This study confirms the relationship between suboptimal nutritional status and complications following RTKA. Hypoalbuminemia may be used as a potential preoperative predictor of outcomes. Understanding the effects of malnutrition on perioperative complications informs the choice of appropriate candidates for surgical intervention, timing of surgery, resource allocation, and risk counseling preoperatively.

<p>Preoperative Serum Albumin Level As A Predictor Of Postoperative Pneumonia After Femoral Neck Fracture Surgery In A Geriatric Population</p>

“…In this cohort, hypoalbuminaemia was present in 17.36% of patients with femoral neck fracture on admission to the hospital. The incidence of hypoalbuminaemia observed in our cohort of patients is similar to what Kamath A, et al 20 reported in their study. They examined 4551 consecutive patients admitted for revision total knee arthroplasty and found hypoalbuminaemia in 16.1% of patients.…”

“…Several studies have indicated that preoperative hypoalbuminaemia is a well-documented risk factor for postoperative complications in various types of surgery. 17,25 Kamath A et al 20 reported that hypoalbuminaemia was independently associated with an increased risk of developing deep organ surgical-site infections, surgical-site infections, urinary traction infections, pneumonia and sepsis after revision total knee arthroplasty. Rungsakulkij N et al 15 reported that perioperative albumin was an important factor associated with serious complications following pancreaticoduodenectomy, include POP.…”

Perioperative Hypoalbuminemia is a Risk Factor for Wound Complications Following Posterior Lumbar Interbody Fusion

“…The current study con rmed that perioperative hypoalbunemia was an important risk factors for wound complications following single-segment PLIF surgery [22][23][24][25][26][27]. Our study further con rmed that perioperative hypoalbuminemia are important risk factors for SWD and SSI.…”

Causal relationship between hypoalbuminemia and acute kidney injury

“…The authors drew encouragement from these findings since hypoalbuminemia may be more easily modifiable than other risk factors ( e.g ., morbid obesity). Results from two subsequent studies also involving thousands of patients undergoing TKA (primary[61] or revision[62]) were consistent with these findings.…”