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.
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