Hypoalbuminemia is a Better Predictor than Obesity of Complications after Total Knee Arthroplasty: A Propensity Score-Adjusted Observational Analysis

Fu, Michael C.; McLawhorn, Alexander S.; Padgett, Douglas E.; Cross, Michael B.

doi:10.1007/s11420-016-9518-4

Cited by 58 publications

(44 citation statements)

References 29 publications

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“…Hypoalbuminemia, defined as serum albumin < 3.5 g/dL, has been documented in the population undergoing joint arthroplasty, with prevalence up to 6.1%. 4 8) Patients with hypoalbuminemia undergoing THA and TKA experience more postoperative complications, including surgical site infections, sepsis, pneumonia, postoperative ventilator use > 48 hours, and unplanned intubations. 9 10 11) Bohl et al 4) also found that joint arthroplasty patients with hypoalbuminemia faced a small (relative ratio, 0.20 days) but significantly extended length of stay (LOS) and a 40% increase in the rate of readmission.…”

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confidence: 99%

Preoperative Serum Albumin Levels Predict Treatment Cost in Total Hip and Knee Arthroplasty

Rudasill

Kamath

2018

Clin Orthop Surg

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BackgroundHypoalbuminemia (serum albumin < 3.5 g/dL) is associated with increased morbidity and mortality in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, costs associated with hypoalbuminemia remain unknown. This study investigated the effect of serum albumin on direct treatment costs, length of stay (LOS), and readmissions for primary and revision THA and TKA patients.MethodsAll adult patients at a single institution undergoing primary or revision THA or TKA between January 2014 and December 2016 were retrospectively reviewed. Patients were stratified by preoperative serum albumin level. The primary outcome was total direct costs at index hospitalization. Secondary outcomes included LOS and readmission within 30 days. Multivariable regressions were utilized to adjust for demographics and comorbidities.ResultsOf 3,785 patients, 114 (3.0%) had hypoalbuminemia. After adjustment, hypoalbuminemia was associated with a 16.2% increase in costs (β = 0.162; 95% confidence interval [CI], 0.112 to 0.213; p < 0.001), representing an average cost increase of $3,383 (95% CI, $2,281 to $4,485) relative to costs for serum albumin > 4.5 g/dL. The increased total costs were significantly higher in revision ($4,322, p = 0.034) than in primary ($3,446, p < 0.001) procedures. In adjusted regression, each 1.0 g/dL increase in serum albumin yielded a 6.6% reduction in costs (β = −0.066; 95% CI, −0.090 to −0.042]; p < 0.001), for average savings of $1,282 (95% CI, $759 to $1,806) per unit albumin. Adjusted regressions demonstrated that a 1-point increase in serum albumin reduced readmissions by 53% (odds ratio, 0.47; 95% CI, 0.31–0.73; p = 0.001) and LOS by 0.6 days (β = −0.60; 95% CI, −0.76 to −0.44; p < 0.001).ConclusionsHypoalbuminemia is associated with increased total direct costs, LOS, and readmissions following primary and revision THA and TKA. Future efforts to predict and address total costs should take into consideration the patient's preoperative serum albumin levels.

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confidence: 99%

Preoperative Serum Albumin Levels Predict Treatment Cost in Total Hip and Knee Arthroplasty

Rudasill

Kamath

2018

Clin Orthop Surg

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“… 11 Although previous studies identified a negative correlation between BMI and albumin level among adults, these study samples included only diabetic subjects, 12 , 13 assessed glycated albumin rather than albumin level 14 or only compared albumin levels between different obesity classes. 24 Another study in Brazil that found that the majority (85%) of overweight or obese elderly patients who were admitted at the hospital had hypoalbuminemia correlated hypoalbuminemia with nutritional status and age rather than BMI and the presence of metabolic syndrome. 25 To our knowledge, our study is among the first to report greater likelihood of hypoalbuminemia among obese and morbidly obese adults, while taking into account factors that may contribute to decreased albumin levels, such as age, sex, diabetes, prediabetes, diabetic nephropathy and nephrotic syndrome.…”

Section: Discussionmentioning

confidence: 99%

Obesity and morbid obesity associated with higher odds of hypoalbuminemia in adults without liver disease or renal failure

Mosli

2017

DMSO

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Background and objectiveStudies are needed in order to inform recommendations for interpreting albumin levels among obese individuals without known medical conditions associated with hypoalbuminemia. The objective of this study was to examine the association of obese and morbidly obese status with hypoalbuminemia, while adjusting for age, sex, diabetes, prediabetes, diabetic nephropathy, and nephrotic syndrome.Patients and methodsRetrospective data collection from adult patients presenting to the outpatient Endocrinology and Metabolism Clinic was performed between January 2015 and December 2015. An initial sample of 180 patients was selected. After excluding patients who were younger than 18 years, who had known cases of liver disease or renal failure, or who had missing data, a final sample of 122 subjects was identified. Serum albumin and objectively measured weight and height data were retrieved from hospital records. A board-certified endocrinologist reviewed patient records to identify the presence of renal and diabetic conditions. Descriptive statistics were used to examine sample characteristics. Multiple logistic regression analysis was used to examine the association of obesity and morbid obesity with hypoalbuminemia (serum albumin < 34 g/L) while adjusting for age, sex, diabetes, prediabetes, diabetic nephropathy, and nephrotic syndrome.ResultsApproximately 43% of the sample were categorized as obese and 13% were categorized as morbidly obese. The mean serum albumin level was 38.00 g/L (standard deviation [SD] = 4.26) among subjects who were neither overweight nor obese, 38.35 g/L (SD = 0.48) among overweight subjects, 34.57 g/L (SD = 4.71) among obese subjects, and 33.81 g/L (SD = 3.71) among morbidly obese subjects. Adjusting for age, sex, diabetes, prediabetes, nephrotic syndrome, and diabetic nephropathy, obese subjects had significantly higher odds of hypoalbuminemia (odds ratio [OR]: 4.10, 95% confidence interval [CI]: 1.50–11.27, P-value = 0.006), as did morbidly obese subjects (OR: 6.94, 95% CI: 1.91–25.23, P-value = 0.003).ConclusionThe findings suggest that obesity and morbid obesity can be considered as independent predictors of hypoalbuminemia. The findings can be used to inform future studies aiming to better understand the association of obesity and morbid obesity with hypoalbuminemia and to help inform guidelines for clinicians on how to correctly interpret and utilize serum albumin data for obese individuals.

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“…It is associated with a host of morbidities, especially metabolic and cardiovascular risks, and in orthopedics, increased incidence of osteoarthritis that may ultimately lead to the need for TKA. Interestingly, recent evidence has shown that increasing BMI is paradoxically associated with malnutrition in terms of micronutrient and protein deficiencies [28,29], which may be one of the mechanisms by which obesity increases risks of postoperative morbidity and mortality, but this topic is beyond the scope of this study.…”

Section: Obesitymentioning

confidence: 95%

Hypoalbuminemia and obesity class II are reliable predictors of peri-prosthetic joint infection in patient undergoing elective total knee arthroplasty

Man

Chau

Chung

et al. 2020

Knee Surg & Relat Res

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Background: Malnutrition is a common and modifiable risk factor for postoperative complications and adverse outcomes in orthopedics. The purpose of this study was to identify biomarkers of malnutrition in patients undergoing elective total knee arthroplasty (TKA) that are predictive of adverse in-hospital postoperative complications, to facilitate the identification of at-risk patients for nutritional optimization before surgery. Methods: A total of 624 patients who underwent elective TKA between 2013 and 2017 were evaluated; potential biomarkers of preoperative malnutrition, including hypoalbuminemia (serum albumin < 3.5 g/dL), total lymphocyte count (TLC < 1500 cells/mm 3), and body mass index (BMI), were assessed for any association with in-hospital postoperative complications. Results: The prevalence of hypoalbuminemia, low TLC, overweight, obesity class I, and obesity class II were, respectively 2.72%, 33.4%, 14.8%, 44.5%, and 26.9%. There was a significant association between hypoalbuminemia and obesity class II (BMI ≥ 30.0 kg/m 2) with rates of peri-prosthetic joint infection, and no significant association between such complications and low TLC, overweight, or obesity class I. Logistic regression analysis showed that patients with hypoalbuminemia or being in obesity class II with gouty arthritis were more likely to suffer from periprosthetic joint infection. Conclusions: Hypoalbuminemia and obesity class II together is a reliable biomarker of preoperative malnutrition for predicting peri-prosthetic joint infection after elective TKA, whereas low TLC, overweight, and obesity class I were not significantly associated with an increased risk of such complications.

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Hypoalbuminemia is a Better Predictor than Obesity of Complications after Total Knee Arthroplasty: A Propensity Score-Adjusted Observational Analysis

Cited by 58 publications

References 29 publications

Preoperative Serum Albumin Levels Predict Treatment Cost in Total Hip and Knee Arthroplasty

Preoperative Serum Albumin Levels Predict Treatment Cost in Total Hip and Knee Arthroplasty

Obesity and morbid obesity associated with higher odds of hypoalbuminemia in adults without liver disease or renal failure

Hypoalbuminemia and obesity class II are reliable predictors of peri-prosthetic joint infection in patient undergoing elective total knee arthroplasty

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