Wednesday, October 21, 2015

Total shoulder arthroplasty and malnutrition - the 4P s

Malnutrition: a marker for increased complications, mortality, and length of stay after total shoulder arthroplasty.

These authors defined malnutrition as a preoperative albumin concentration of <3.5 g/dL. They queried the American College of Surgeons National Surgical Quality Improvement Program database  for total shoulder cases from 2005 to 2013 and compared the rates of postoperative complications between normal and malnourished patients.

Of the 1681 patients with albumin measurements, 7.6% were malnourished. Malnutrition was significantly associated with postoperative transfusion (odds ratio, 2.49), extended LOS (odds ratio, 1.69), and death (odds ratio, 18.09).  The prevalence of morbid obesity was greater in malnourished patients than in controls.

Comment: Here is a great example of the influence of the patient's health as a predictor of outcome. Serum albumin is an inexpensive, easy to obtain blood test that has been shown to influence the rates of complications for many different types of surgery. It remains to be seen whether preoperative nutritional interventions are successful in reducing this risk.


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