The Impact of Malnutrition on 30-Day Postoperative Complications following Surgical Fixation of Distal Radius Fractures

Abstract

Introduction Distal radius fractures (DRFs) are increasingly managed surgically among fragility fractures due to prolonged life expectancy and surgical advancements. Yet, malnutrition can impact postoperative outcomes and complications. We sought to determine the impact of malnutrition on open reduction and internal fixation (ORIF) of DRFs during the perioperative and 30-day postoperative periods. Materials and Methods Using the National Surgical Quality Improvement Program database, all patients who underwent ORIF of a DRF between January 1, 2008, and December 31, 2016, were identified and stratified by preoperative serum albumin levels: normal (≥3.5 g/dL; n = 2,546) or hypoalbuminemia (<3.5 g/dL; n = 439). Demographical and perioperative data were compared. Operative complications were stratified into major and minor complications, and data were analyzed using descriptive statistics and multivariate regression models. Results Compared with patients with normal levels, a higher proportion of hypoalbuminemia patients had ASA scores > 3 (9.1 vs. 2%) and a longer mean length of stay (3.16 vs. 0.83 days). Hypoalbuminemia patients also had 625% greater odds for developing major complications during the 30-day postoperative period (odds ratio = 7.25; 95% confidence interval: 1.91–27.49). Conclusion Malnutrition significantly affected outcomes and complications of distal radius ORIF. This study highlights the importance of prevention and treatment of malnutrition in the setting of fragility fractures.

The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery

“…These physiologic stress events cause a surge in oxidative stress and inflammation, increased metabolic demands to facilitate tissue repair, and a balance of protein synthesis and catabolism to maintain gluconeogenesis 21 . Although essential for proper recovery, this delicate balance can be tipped in favor of catabolism as metabolic reserves are depleted, leading to impaired immunity, disrupted healing, increased hospital length of stay (LOS), sepsis, mortality, and other clinically meaningful negative outcomes across all orthopaedic subspecialties 13,22-27 . This process is compounded by reduced oral intake, with an estimated 50% to 91.5% of orthopaedic patients reporting suboptimal intake in the perioperative period 28-31 .…”

“…In patients undergoing open reduction internal fixation (ORIF) for distal radius fractures (DRFs), which comprise up to 17.5% to 22.2% of all fractures, recent studies report approximately 14.7% are hypoalbuminemic 2,156 . These patients have been found to have significantly increased overall complication rates, Clavien-Dindo IV (life-threatening) complications, readmission, longer hospital LOS, and mortality 2,22 . Despite these data, there are no prospective studies to date that evaluate the impact of protein- or carbohydrate-based nutritional supplementation in operatively nor nonoperatively managed DRFs.…”