Preoperative Hypoalbuminemia Predicts Poor Short-term Outcomes for Hip Fracture Surgery

Ryan, Sean P.; Politzer, Cary S.; Fletcher, Amanda N.; Bolognesi, Michael P.; Seyler, Thorsten M.

doi:10.3928/01477447-20180912-03

Cited by 28 publications

(22 citation statements)

References 23 publications

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“…However, reduction in serum albumin could also reflect the existing comorbidities, chronic illness and concurrent infection [22]. Nutritional supplementation is warranted in order to reduce both the risk of developing complications, as well as the risk of mortality [24].…”

Section: Discussionmentioning

confidence: 99%

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Panteli

Giannoudi

Lodge

et al. 2021

JCM

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The aim of this study was to define the incidence and investigate the associations with mortality and medical complications, in patients presenting with subtrochanteric femoral fractures subsequently treated with an intramedullary nail, with a special reference to advancement of age. Materials and Methods: A retrospective review, covering an 8-year period, of all patients admitted to a Level 1 Trauma Centre with the diagnosis of subtrochanteric fractures was conducted. Normality was assessed for the data variables to determine the further use of parametric or non-parametric tests. Logistic regression analysis was then performed to identify the most important associations for each event. A p-value < 0.05 was considered significant. Results: A total of 519 patients were included in our study (age at time of injury: 73.26 ± 19.47 years; 318 female). The average length of hospital stay was 21.4 ± 19.45 days. Mortality was 5.4% and 17.3% for 30 days and one year, respectively. Risk factors for one-year mortality included: Low albumin on admission (Odds ratio (OR) 4.82; 95% Confidence interval (95%CI) 2.08–11.19), dementia (OR 3.99; 95%CI 2.27–7.01), presence of pneumonia during hospital stay (OR 3.18; 95%CI 1.76–5.77) and Charlson comorbidity score (CCS) > 6 (OR 2.94; 95%CI 1.62–5.35). Regarding the medical complications following the operative management of subtrochanteric fractures, the overall incidence of hospital acquired pneumonia (HAP) was 18.3%. Patients with increasing CCS (CCS 6–8: OR 1.69; 95%CI 1.00–2.84/CCS > 8: OR 2.02; 95%CI 1.03–3.95), presence of asthma/chronic obstructive pulmonary disease (COPD) (OR 2.29; 95%CI 1.37–3.82), intensive care unit (ICU)/high dependency unit (HDU) stay (OR 3.25; 95%CI 1.77–5.96) and a length of stay of more than 21 days (OR 8.82; 95%CI 1.18–65.80) were at increased risk of this outcome. The incidence of post-operative delirium was found to be 10.2%. This was associated with pre-existing dementia (OR 4.03; 95%CI 0.34–4.16), urinary tract infection (UTI) (OR 3.85; 95%CI 1.96–7.56), need for an increased level of care (OR 3.16; 95%CI 1.38–7.25), pneumonia (OR 2.29; 95%CI 1.14–4.62) and post-operative deterioration of renal function (OR 2.21; 95%CI 1.18–4.15). The incidence of venous thromboembolism (VTE) was 3.7% (pulmonary embolism (PE): 8 patients; deep venous thrombosis (DVT): 11 patients), whilst the incidence of myocardial infarction (MI)/cerebrovascular accidents (CVA) was 4.0%. No evidence of the so called “weekend effect” was identified on both morbidity and mortality. Regression analysis of these complications did not reveal any significant associations. Conclusions: Our study has opened the field for the investigation of medical complications within the subtrochanteric fracture population. Early identification of the associations of these complications could help prognostication for those who are at risk of a poor outcome. Furthermore, these could be potential “warning shots” for clinicians to act early to manage and in some cases prevent these devastating complications that could potentially lead to an increased risk of mortality.

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Section: Discussionmentioning

confidence: 99%

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Panteli

Giannoudi

Lodge

et al. 2021

JCM

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“…The study did not include the association between CONUT and postoperative complications, whereas we There have been several retrospective studies investigating associations between malnutrition and clinical outcomes in hip fracture patients. These studies utilized serum albumin concentration as the index of malnutrition and showed significant associations between hypoalbuminemia (albumin < 3.5 g/dL) and increased postoperative complications and mortality [17][18][19]. Another study found that the group with low albumin and low lymphocyte counts at the time of hospital admission had a higher 12-month mortality rate than did the group with a normal albumin concentration [20].…”

Section: Discussionmentioning

confidence: 99%

Controlling nutritional status score predicts postoperative complications after hip fracture surgery

et al. 2020

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Background: Controlling Nutritional Status (CONUT) score is calculated using laboratory values, including serum albumin, total cholesterol concentration, and total lymphocyte count; it is reportedly valuable for making nutritional assessments. One advantage of CONUT score over other nutritional assessments is that it can be calculated retrospectively using only objective laboratory values. Studies demonstrated that CONUT score was a useful tool for predicting prognosis and complications in various surgical conditions. Nevertheless, few studies utilized the score as a potential predictive marker for postoperative complications among hip fracture patients. The purpose of this study was to determine the association between CONUT score and postoperative complications in hip fracture patients. Methods: We retrospectively reviewed 211 elderly patients who underwent hip fracture surgery at a single institution from 2013 to 2018. CONUT score was calculated using preoperative routine laboratory tests for serum albumin, total cholesterol concentration, and total lymphocyte count. As potential confounders, we extracted data such as patient age, sex, fracture type, and general conditions/comorbidities, as defined by the American Society of Anesthesiologists Physical Status (ASA-PS) classification and the Charlson Comorbidity Index (CCI). Postoperative complications were defined as a Clavien-Dindo classification of 1 or more. Simple and multivaribale logistic regression analyses were performed to assess the incidence of postoperative complications as the outcome measures. Results: The mean age [IQR] was 86 [80-90], and 80.1% of the reviewed patients were female. Based on the CONUT scores, 78.7% of hip fracture patients were classified as malnourished; 18% experienced postoperative complications. Simple analyses revealed significant risk factors for postoperative complications, including age, the ASA-PS, the CCI, and the CONUT score. Multivariable analysis found that CONUT score was the independent risk factor for postoperative complications (odd ratio = 1.21, 95% confidence interval = 1.01-1.45, p = 0.04). Conclusions: Preoperative CONUT scores are independently associated with the incidence of postoperative complications. CONUT score can be used for risk assessment in hip fracture patients to predict early postoperative complications.

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“…In addition, some studies showed that plasma albumin levels might decrease in spite of aggressive replacement therapy in some major trauma patients. they explained that the condition was due to the altered endothelial permeability caused by cytokines such as interleukin-1 (16)(17)(18)(19). thus, this study showed that the hypoalbuminemia occurred due to not only malnutrition but also some other factors.…”

Section: Discussionmentioning

confidence: 51%

Lower- versus upper-extremity surgery: effect on serum albumin levels

Aydın¹,

Ağır²

2018

Med J Islamic World Acad Sci

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Major surgical interventions and traumas cause severe stress responses in human metabolism. this metabolic stress leads to higher rates of surgical complications and delays in recovery. In many cases, metabolic stress causes morbidity and mortality (1). Some inflammatory markers, such as c-reactive protein and albumin, help determine the metabolic condition and predict the prognosis of patients (1-4).Albumin, a plasma protein, is synthesized in the liver and responsible for some main functions, including maintaining colloid osmotic pressure that keeps the body fluid in the intravascular space, showing antithrombotic effect, binding and transporting some agents, scavenging the free oxygen radicals, and playing a role on vascular permeability in shock and sepsis (5,6). the serum albumin level decreases in two ways: (1) by decrease in the synthesis of albumin in the liver by chronic liver diseases, malnutrition, malabsorption, and carcinomas; and (2) by increased loss of albumin through traumas, nephrotic

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Preoperative Hypoalbuminemia Predicts Poor Short-term Outcomes for Hip Fracture Surgery

Cited by 28 publications

References 23 publications

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Controlling nutritional status score predicts postoperative complications after hip fracture surgery

Lower- versus upper-extremity surgery: effect on serum albumin levels

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