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).

Malnutrition (low preoperative albumin concentration) is associated with shoulder arthroplasty complications

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

These authors searched the American College of Surgeons National Surgical Quality Improvement Program database was queried for TSA cases from 2005 to 2013. 

They compared rates of postoperative complications for patients with and without malnutrition (defined as preoperative albumin concentration of <3.5 g/dL.) among 1681 patients with preoperative albumin measurements available 7.6% of which were malnourished.

Propensity-adjusted multivariable logistic regression demonstrated that malnutrition was significantly associated with postoperative transfusion (odds ratio, 2.49), extended LOS (odds ratio, 1.69), and death within 30 days of surgery (odds ratio, 18.09).

Comment: From the table below, it can be seen that the patients with low albumin were sicker in many different regards. 

In that shoulder arthroplasty is an elective procedure, we wonder why surgery was performed on so many patients with poor health. In view of these data, we are informed that non-operative management requires serious consideration in these individuals.

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Consultation for those who live a distance away from Seattle.

Check out the new Shoulder Arthritis Book - click here.

Click here to see the new Rotator Cuff Book

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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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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Consultation for those who live a distance away from Seattle.

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'

See from which cities our patients come.

See the countries from which our readers come on this post.