Hypoalbuminemia and obesity class II are reliable predictors of peri-prosthetic joint infection in patient undergoing elective total knee arthroplasty
Tóm tắt
Malnutrition is a common and modifiable risk factor for postoperative complications and adverse outcomes in orthopedics. The purpose of this study was to identify biomarkers of malnutrition in patients undergoing elective total knee arthroplasty (TKA) that are predictive of adverse in-hospital postoperative complications, to facilitate the identification of at-risk patients for nutritional optimization before surgery.
A total of 624 patients who underwent elective TKA between 2013 and 2017 were evaluated; potential biomarkers of preoperative malnutrition, including hypoalbuminemia (serum albumin < 3.5 g/dL), total lymphocyte count (TLC < 1500 cells/mm3), and body mass index (BMI), were assessed for any association with in-hospital postoperative complications.
The prevalence of hypoalbuminemia, low TLC, overweight, obesity class I, and obesity class II were, respectively 2.72%, 33.4%, 14.8%, 44.5%, and 26.9%. There was a significant association between hypoalbuminemia and obesity class II (BMI ≥ 30.0 kg/m2) with rates of peri-prosthetic joint infection, and no significant association between such complications and low TLC, overweight, or obesity class I. Logistic regression analysis showed that patients with hypoalbuminemia or being in obesity class II with gouty arthritis were more likely to suffer from peri-prosthetic joint infection.
Hypoalbuminemia and obesity class II together is a reliable biomarker of preoperative malnutrition for predicting peri-prosthetic joint infection after elective TKA, whereas low TLC, overweight, and obesity class I were not significantly associated with an increased risk of such complications.
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Tài liệu tham khảo
Studley HO (2001) Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer. 1936. Nutr Hosp 16(4):141–143 discussion 0-1
Jones RE, Russell RD, Huo MH (2013) Wound healing in total joint replacement. Bone Joint J 95-B(11 Suppl A):144–147. https://doi.org/10.1302/0301-620X.95B11.32836
Greene KA, Wilde AH, Stulberg BN (1991) Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications. J Arthroplast 6(4):321–325
Evans DC, Martindale RG, Kiraly LN, Jones CM (2014) Nutrition optimization prior to surgery. Nutr Clin Pract 29(1):10–21. https://doi.org/10.1177/0884533613517006
Martindale RG, McClave SA, Taylor B, Lawson CM (2013) Perioperative nutrition: what is the current landscape? JPEN J Parenter Enteral Nutr 37(5 Suppl):5S–20S. https://doi.org/10.1177/0148607113496821
Knox TA, Zafonte-Sanders M, Fields-Gardner C, Moen K, Johansen D, Paton N (2003) Assessment of nutritional status, body composition, and human immunodeficiency virus-associated morphologic changes. Clin Infect Dis 36(Suppl 2):S63–S68. https://doi.org/10.1086/367560
Jensen JE, Jensen TG, Smith TK, Johnston DA, Dudrick SJ (1982) Nutrition in orthopaedic surgery. J Bone Joint Surg Am 64(9):1263–1272
Yuwen P, Chen W, Lv H, Feng C, Li Y, Zhang T et al (2017) Albumin and surgical site infection risk in orthopaedics: a meta-analysis. BMC Surg 17(1):7. https://doi.org/10.1186/s12893-016-0186-6
Kamath AF, Nelson CL, Elkassabany N, Guo Z, Liu J (2017) Low albumin is a risk factor for complications after revision total knee arthroplasty. J Knee Surg 30(3):269–275. https://doi.org/10.1055/s-0036-1584575
Alfargieny R, Bodalal Z, Bendardaf R, El-Fadli M, Langhi S (2015) Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty. Avicenna J Med 5(4):117–122. https://doi.org/10.4103/2231-0770.165122
Marín LA, Salido JA, López A, Silva A (2002) Preoperative nutritional evaluation as a prognostic tool for wound healing. Acta Orthop Scand 73(1):2–5. https://doi.org/10.1080/000164702317281323
Anoushiravani AA, Sayeed Z, Chambers MC, Gilbert TJ, Scaife SL, El-Othmani MM et al (2016) Assessing in-hospital outcomes and resource utilization after primary total joint arthroplasty among underweight patients. J Arthroplast 31(7):1407–1412. https://doi.org/10.1016/j.arth.2015.12.053
Lavernia CJ, Sierra RJ, Baerga L (1999) Nutritional parameters and short term outcome in arthroplasty. J Am Coll Nutr 18(3):274–278
Dreblow DM, Anderson CF, Moxness K (1981) Nutritional assessment of orthopedic patients. Mayo Clin Proc 56(1):51–54
Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P et al (2011) Updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682. https://doi.org/10.1093/aje/kwq433
Asia-Pacific Perspective Committee, Zimmet P, Inoue S, International Diabetes Institute (2000) The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia, Sydney
Oviedo Baena AM, Moeschler SM, Smith HM, Duncan CM, Schroeder DR, Kopp SL (2015) Perioperative comorbidities and complications among patients undergoing primary total knee arthroplasty: a retrospective analysis and prospective survey. J Clin Anesth 27(7):558–565. https://doi.org/10.1016/j.jclinane.2015.07.011
Belmont PJ, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ (2014) Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am 96(1):20–26. https://doi.org/10.2106/JBJS.M.00018
Rainey-Macdonald CG, Holliday RL, Wells GA, Donner AP (1983) Validity of a two-variable nutritional index for use in selecting candidates for nutritional support. JPEN J Parenter Enteral Nutr 7(1):15–20. https://doi.org/10.1177/014860718300700115
Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T et al (2009) Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging 13(9):782–788
Bagaria V, Modi N, Panghate A, Vaidya S (2006) Incidence and risk factors for development of venous thromboembolism in Indian patients undergoing major orthopaedic surgery: results of a prospective study. Postgrad Med J 82(964):136–139. https://doi.org/10.1136/pgmj.2005.034512
Kim KI, Cho KY, Jin W, Khurana SS, Bae DK (2011) Recent Korean perspective of deep vein thrombosis after total knee arthroplasty. J Arthroplast 26(7):1112–1116. https://doi.org/10.1016/j.arth.2011.02.021
Yasunaga H, Tsuchiya K, Matsuyama Y, Ohe K (2009) Analysis of factors affecting operating time, postoperative complications, and length of stay for total knee arthroplasty: nationwide web-based survey. J Orthop Sci 14(1):10–16. https://doi.org/10.1007/s00776-008-1294-7
Liao CD, Huang YC, Lin LF, Huang SW, Liou TH (2015) Body mass index and functional mobility outcome following early rehabilitation after a total knee replacement: a retrospective study in Taiwan. Arthritis Care Res (Hoboken) 67(6):799–808. https://doi.org/10.1002/acr.22474
Morey VM, Song YD, Whang JS, Kang YG, Kim TK (2016) Can serum albumin level and total lymphocyte count be surrogates for malnutrition to predict wound complications after total knee arthroplasty? J Arthroplast 31(6):1317–1321. https://doi.org/10.1016/j.arth.2015.12.004
Fu MC, McLawhorn AS, Padgett DE, Cross MB (2017) Hypoalbuminemia is a better predictor than obesity of complications after total knee arthroplasty: a propensity score-adjusted observational analysis. HSS J 13(1):66–74. https://doi.org/10.1007/s11420-016-9518-4
Cross MB, Yi PH, Thomas CF, Garcia J, Della Valle CJ (2014) Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg 22(3):193–199. https://doi.org/10.5435/JAAOS-22-03-193
Suleiman LI, Ortega G, Ong’uti SK, Gonzalez DO, Tran DD, Onyike A et al (2012) Does BMI affect perioperative complications following total knee and hip arthroplasty? J Surg Res 174(1):7–11. https://doi.org/10.1016/j.jss.2011.05.057
Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplast 20(7 Suppl 3):46–50. https://doi.org/10.1016/j.arth.2005.04.023
Miric A, Lim M, Kahn B, Rozenthal T, Bombick D, Sculco TP (2002) Perioperative morbidity following total knee arthroplasty among obese patients. J Knee Surg. 15(2):77–83
Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE (2009) Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplast 24(6 Suppl):84–88. https://doi.org/10.1016/j.arth.2009.05.016
Woo J, Cheung CK, Ho SC, Mak YT, Swaminathan R (1988) Protein nutritional status in elderly Chinese in Hong Kong. Eur J Clin Nutr 42(11):903–909
Beiner JM, Grauer J, Kwon BK, Vaccaro AR (2003) Postoperative wound infections of the spine. Neurosurg Focus 15(3):E14
Jevsevar DS, Karlin LI (1993) The relationship between preoperative nutritional status and complications after an operation for scoliosis in patients who have cerebral palsy. J Bone Joint Surg Am 75(6):880–884. https://doi.org/10.2106/00004623-199306000-00008
Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG (2000) Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine (Phila Pa 1976) 25(19):2461–2466
Williamson SC, Roger DJ, Petrera P, Glockner F (1994) Acute gouty arthropathy after total knee arthroplasty. A case report. J Bone Joint Surg Am 76(1):126–128
Blyth P, Pai VS (1999) Recurrence of gout after total knee arthroplasty. J Arthroplast 14(3):380–382
Beutler AM, Epstein AL, Policastro D (2000) Acute gouty arthritis involving a prosthetic knee joint. J Clin Rheumatol 6(5):291–293
Crawford L, Kumar A, Shepard GJ (2007) Gouty synovitis after total knee arthroplasty: a case report. J Orthop Surg (Hong Kong) 15(3):384–385
Fokter SK, Repse-Fokter A (2010) Acute gouty arthritis in a patient after total knee arthroplasty. Wien Klin Wochenschr 122(11–12):366–367