Routine Preoperative Nutritional Screening in All Primary Total Joint Arthroplasty Patients Has Little Utility

Rao, Sandesh S.; Chaudhry, Yash P.; Solano, Mitchell A.; Sterling, Robert S.; Oni, Julius K.; Khanuja, Harpal S.

doi:10.1016/j.arth.2020.06.073

Cited by 13 publications

(25 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Much of the existing literature evaluates laboratory screening alone. 6,8,9,12,15,19 While laboratory tests are useful adjuncts, the concordance rate of markers for nutritional imbalance has been reported to be as low as 0.4% in TJA patients, supporting the use of other factors in any screening effort. 6…”

Section: Screening For Malnutritionmentioning

confidence: 99%

Screening and Management of Malnutrition in Total Joint Arthroplasty

Phillips

Ennis

Dennis

2023

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Malnutrition is an increasingly prevalent problem in patients undergoing total joint arthroplasty (TJA). Increased risks associated with TJA in the setting of malnourishment have been well documented. Standardized scoring systems in addition to laboratory parameters such as albumin, prealbumin, transferrin, and total lymphocyte count have been developed to identify and evaluate malnourished patients. Despite an abundance of recent literature, there is no consensus on the best approach for screening TJA patients from a nutritional standpoint. Although there are a variety of treatment options, including nutritional supplements, nonsurgical weight loss therapies, bariatric surgery, and the involvement of dieticians and nutritionists, the effect of these interventions on TJA outcomes has not been well characterized. This overview of the most current literature aims to provide a clinical framework for approaching nutrition status in arthroplasty patients. A comprehensive understanding of the tools available for managing malnourishment will facilitate improved arthroplasty care.

show abstract

Section: Screening For Malnutritionmentioning

confidence: 99%

Screening and Management of Malnutrition in Total Joint Arthroplasty

Phillips

Ennis

Dennis

2023

J Am Acad Orthop Surg

View full text Add to dashboard Cite

show abstract

“…The cutoff values used for blood biomarkers (including an albumin level of 3.5 g/dL) have been shown to be less reliable for elderly patients and may lead to underdiagnosis of malnutrition 31,32 . Fasting blood glucose and HbA1c levels among individuals with diabetes provide a reliable assessment of patients’ glycemic control 5,6,11 . Finally, basic inflammatory markers, such as ESR and CRP level, can reveal underlying inflammatory processes often associated with debilitation and/or poor nutritional status 33 .…”

Section: Preoperative Screening and Patient Optimizationmentioning

confidence: 99%

“…The latter may also be a cause of immune deficiency disorders, hypoalbuminemia, and increased risks of transfusion requirement, prolonged LOS, thromboembolic events, and infection as well as mechanical joint complications 28-30 . Furthermore, the total leukocyte count (TLC) component of the CBC is a commonly utilized indicator of malnutrition and has been associated with wound-healing complications, acute and chronic infection, and increased health-care utilization 1,11 . Yi et al 1 utilized a cutoff of <1,500 cells/mm 3 for TLC, <3.5 g/dL for albumin, or <200 mg/dL for transferrin to designate malnutrition and found that these criteria were independently associated with chronic septic failure requiring revision as well as acute postoperative infection complicating previously aseptic revisions 1 .…”

Section: Preoperative Screening and Patient Optimizationmentioning

confidence: 99%

Team Approach: Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty

et al. 2022

View full text Add to dashboard Cite

Nutritional assessment is a critical element of routine preoperative assessment and should be approached by an interdisciplinary team that involves the primary care physician, dietitian, and orthopaedist.» Patients should be stratified on the basis of their nutritional risk, which influences downstream optimization and deficiency reversal.» The scientific literature indicates that nutritional supplementation affords protection against adverse outcomes and helps functional recovery, even among patients who are not at nutritional risk.» Published investigations recommend a sufficient preoperative interval (at least 4 weeks) to ensure an adequate nutritional intervention in malnourished patients as opposed to regarding them as nonsurgical candidates.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A805).

show abstract

“…In studies using the NSQIP database, hypoalbuminemia has been found to be an independent predictor of postoperative mortality, surgical site infections, respiratory events, cardiac events, bleeding with need for transfusion, sepsis, PJI, readmission, reoperation, and increased length of stay in TJA patients [5,11,22]. A study of 819 TJA cases by Rao et al found that congestive heart failure, chronic kidney disease, pancreatic insufficiency, gastroesophageal reflux disease, osteoporosis, and dementia were associated with abnormal preoperative albumin; Parkinson disease was associated with abnormal transferrin; and dementia, BMI, and cancer history were associated with abnormal TLC, suggesting that these laboratory tests may be most warranted in patients with these comorbidities [65]. We only obtain preoperative serum albumin, transferrin, and TLC in TJA patients with these comorbidities.…”

Section: Malnutrition and Hypoalbuminemiamentioning

confidence: 99%

Preoperative Patient Optimization in Total Joint Arthroplasty—The Paradigm Shift from Preoperative Clearance: A Narrative Review

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background: Total joint arthroplasty (TJA) is one of the most common procedures performed in the United States. Outcomes of this elective procedure may be improved via preoperative optimization of modifiable risk factors. Purposes: We sought to summarize the literature on the clinical implications of preoperative risk factors in TJA and to develop recommendations regarding preoperative optimization of these risk factors. Methods: We searched PubMed in August 2019 with an update in September 2020 for English-language, peer-reviewed publications assessing the influence on outcomes in total hip and knee replacement of 7 preoperative risk factors—obesity, malnutrition, hypoalbuminemia, diabetes, anemia, smoking, and opioid use—and recommendations to mitigate them. Results: Sixty-nine studies were identified, including 3 randomized controlled trials, 8 prospective cohort studies, 42 retrospective studies, 6 systematic reviews, 3 narrative reviews, and 7 consensus guidelines. These studies described worse outcomes associated with these 7 risk factors, including increased rates of in-hospital complications, transfusions, periprosthetic joint infections, revisions, and deaths. Recommendations for strategies to screen and address these risk factors are provided. Conclusions: Risk factors can be optimized, with evidence suggesting the following thresholds prior to surgery: a body mass index <40 kg/m2, serum albumin ≥3.5 g/dL, hemoglobin A1C ≤7.5%, hemoglobin >12.0 g/dL in women and >13.0 g/dL in men, and smoking cessation and ≥50% decrease in opioid use by 4 weeks prior to surgery. Surgery should be delayed until these risk factors are adequately optimized.

show abstract

Routine Preoperative Nutritional Screening in All Primary Total Joint Arthroplasty Patients Has Little Utility

Cited by 13 publications

References 31 publications

Screening and Management of Malnutrition in Total Joint Arthroplasty

Screening and Management of Malnutrition in Total Joint Arthroplasty

Team Approach: Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty

Preoperative Patient Optimization in Total Joint Arthroplasty—The Paradigm Shift from Preoperative Clearance: A Narrative Review

Contact Info

Product

Resources

About