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Original Paper |
University of Miami, School of Medicine (C.J.L., R.J.S.), Florida
Mayo Medical School (L.B.), Rochester, Minnesota
Address reprint requests to: Carlos J. Lavernia, MD, 1321 NW 14th Street, Suite 203, Miami, FL 33125.
Objective: Advances in surgical techniques and management of arthroplasty patients have contributed to a significant reduction in surgical complication rates. Preoperative nutritional status has a significant impact on surgical outcome. Studies have reported improved outcomes in burn and hip fracture patients receiving nutritional supplementation during their recoveries. Our objective was to assess the effects of preoperative nutritional status on the incidence of complications, resource consumption, and length of stay of patients undergoing hip and knee replacement surgery.
Methods: One hundred and nineteen patients were evaluated. Standard preoperative laboratory tests were performed on all patients. Medical severity of illness was assessed on all patients using the Charlson Comorbidity Index. Anesthesia and surgical time was recorded. Short term outcome was assessed utilizing hospital charges as a measure of resource consumption, length of stay (LOS), in-hospital consults and the presence and number of complications during hospitalization. Non-parametric Kruskall Wallis and chi-square statistical analyses were performed. A p value <.05 was considered significant.
Results: Mean age was 64.6 years±15.62. 52.9% had osteoarthritis (OA), 4.2% had rheumatoid arthritis (RA), 5.9% had osteonecrosis (ON), 9.2% had a hip fracture and 28% had a failed total knee arthroplasty (TKA) or total hip arthroplasty (THA). Mean albumin and total lymphocyte count (TLC) were 38.5 g/L±4.78 SD and 1884 cells/µL±762 SD, respectively. Patients with albumin levels less than 34 g/L had 32.7% higher charges ($50,108±8203 SE vs. $33,720±1128 SE, p < .006), higher medical severity of illness (p=.03) and longer LOS (8.6±1.7 SE vs. 5.2±.356 SE days, p<.001). Patients with TLC less than 1200 cells/µL had higher charges ($32,544±1050 SE vs. $42,098±3122 SE, p=.004), longer LOS (5.7±.531 vs. 5.4 days±.368, p=.004) and anesthesia (242.85±17.55 SE vs. 198.6 min.±6.06 SE, p=.02) and surgical times (177.14 min.±17.57 SE vs. 120.21 min.±6.22 SE, p=.002) when compared with patients with TLC higher than 1200 cells/µL. These findings were still significant when adjusted for medical severity of illness and age.
Conclusions: Our data demonstrate that preoperative nutritional status is an excellent predictor of short term outcome. Serum albumin and TLC correlate with resource consumption, length of stay and operative time in patients undergoing joint replacement surgery. These parameters may be improved with nutritional supplementation prior to surgery.
Key words: nutrition, arthroplasty, outcome, resource consumption, hip, knee
Abbreviations: BMI=body mass index • LOS=length of stay • MANOVA=multivariate analysis of variance • SD=standard deviation • SE=standard error • TLC=total lymphocyte count
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