Adverse outcomes from total shoulder arthroplasty - the role of malnutrition

 Examining the Effects of Modifiable Risk Factors on Postoperative Outcomes after Total Shoulder Arthroplasty

These authors collected data on 14,478 adult patients undergoing total shoulder arthroplasty from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 2006-2016 database.

They found that malnutrition (defined as preoperative albumin level of <3.5g/dL) was associated with an approximately 3-time increased likelihood of non-routine discharge and 5-time increased likelihood of hematologic complications after TSA. Overall the prevalence of malnutrition found in this study was 7.9%.

Comment: This study emphasizes the prevalence and importance of hypoalbuminemia to the outcome of total should arthroplasty. While the authors identify malnutrition as a "modifiable" risk factor, they do not provide evidence on (1) how this risk factor can be effectively modified and (2) whether improving preoperative albumin levels reverses the ill effects of malnutrition. Until such evidence is available, it may be more accurate to refer to hypoalbuminemia simply as a risk factor. 

 How you can support research in shoulder surgery Click on this link.

Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The total shoulder arthroplasty (see this link).

The ream and run technique is shown in this link.

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

Shoulder rehabilitation exercises (see this link).

Follow on twitter: Frederick Matsen (@shoulderarth)

Malnutrition and arthroplasty outcomes

Malnutrition in Elective Shoulder Arthroplasty: A Multi-Institutional Retrospective Study of Preoperative Albumin and Adverse Outcomes

These authors investigated the role of preoperative albumin levels in predicting common postoperative adverse outcomes in patients undergoing shoulder arthroplasty.

They found that the prevalence of malnutrition (albumin <3.5 g/dL) was twice as high in patients having revision compared to those having primary arthroplasty (36.6% vs. 19.5%). 

Patients having primary reverse arthroplasty and higher ASA scores were more likely to be malnourished. 

Patients who were malnourished had an increased incidence of extended length of stay and discharge to rehab/SNF.

These authors did not assess whether attempts to improve serum albumin preoperatively were effective in improving outcome of shoulder arthroplasty. 

Other studies of the effect of malnutrition on arthroplasty outcomes can be found in this link and this link.

Each of these suggest the use of preoperative serum albumin as an important indication of nutritional status.

How you can support research in shoulder surgery Click on this link.

Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).

Shoulder arthroplasty - malnutrition increases risk

Effects of Modifiable Risk Factors on Outcomes after Shoulder Arthroplasty

These authors collected data from the American College of Surgeons National Quality Improvement Program from 2006-2016 for adult patients having total shoulder arthroplasty.

Malnutrition was defined as a preoperative albumin <3.5. Hematologic complications included thromboembolic events, bleeding, sepsis, or septic shock. Non-routine discharge was defined as a discharge other than to the patient's home.

As can be seen below, malnutrition was associated with >3 times increased risk of non-routine discharge and almost 5 times the risk of hematologic complications.

Comment: A serum albumin is an inexpensive test to obtain preoperatively. Its relationship to adverse outcomes is of interest.

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To see a YouTube of our technique for total shoulder arthroplasty, click on this link.

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We have a new set of shoulder youtubes about the shoulder, check them out at this link.

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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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Check out the new Shoulder Arthritis Book - click here.

Click here to see the new Rotator Cuff Book

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

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