Is Hypoalbuminemia Associated With Septic Failure and Acute Infection After Revision Total Joint Arthroplasty? A Study of 4517 Patients From the National Surgical Quality Improvement Program

Bohl, Daniel D.; Shen, Mary R.; Kayupov, Erdan; Cvetanovich, Gregory L.; Valle, Craig J. Della

doi:10.1016/j.arth.2015.11.025

Cited by 102 publications

(69 citation statements)

References 21 publications

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“…In contrast, the diagnostic value of total protein and albumin was limited. Interestingly, albumin did not show signi cant difference between septic and aseptic groups in our study, which was inconsistent with the results of some previous studies [30,31]. The discrepancy could be due to heterogeneity of study populations, sample sizes, and patient selection [31,32].…”

Section: Discussioncontrasting

confidence: 99%

Serum Globulin and Albumin to Globulin Ratio as Potential Diagnostic Biomarkers for Periprosthetic Joint Infection: A Retrospective Review

Chen

et al. 2020

Preprint

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Background: Periprosthetic joint infection (PJI) has been increasingly documented; however, its preoperative accurate diagnosis remains challenging. Furthermore, there is a dire need to identify appropriate and effective biomarkers. We aimed to evaluate the relationship between globulin, albumin to globulin (A/G) ratio, and development of PJI in patients undergoing revision total joint arthroplasty (TJA).Methods: A retrospective study was conducted on patients who had undergone revision TJA between 2011 and 2018 (89 with aseptic mechanic failure and 38 with PJI). The serum proteins were explored using univariate analysis followed by multivariate logistic regression. The diagnostic performance of these proteins was assessed by the receiver operating characteristic (ROC) curve.Results: Higher globulin levels (odds ratio [OR], 1.239; P<0.001) and lower A/G ratio (OR, 0.007; P<0.001) were strongly associated with the risk of PJI. ROC curve analysis demonstrated reasonable diagnostic performance for globulin (area under the curve [AUC], 0.77; sensitivity, 78.95%; and specificity, 69.66%) and A/G ratio (AUC, 0.779; sensitivity, 65.79%; and specificity, 78.65%).Conclusions: Both globulin and A/G ratio were associated with PJI and may serve as potential adjuvant biomarkers in the diagnosis of PJI.

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Section: Discussioncontrasting

confidence: 99%

Serum Globulin and Albumin to Globulin Ratio as Potential Diagnostic Biomarkers for Periprosthetic Joint Infection: A Retrospective Review

Chen

et al. 2020

Preprint

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“…The results showed that early postoperative hypoalbuminemia <2.5 g/dl was an independent risk factor for SSI in patients who underwent oral cancer surgery [36]. Bohl DD et al also reported that malnutrition increased the risk of periprosthetic joint infection following total joint arthroplasty [37].…”

Section: Discussionmentioning

confidence: 98%

Perioperative Hypoalbuminemia is a Risk Factor for Wound Complications Following Posterior Lumbar Interbody Fusion

Zhou

Tang

et al. 2020

Preprint

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Background: Although serum albumin levels are increasingly used as an indicator of nutritional status in the clinic, the relationship between perioperative hypoalbuminemia and wound complications after posterior lumbar interbody fusion in the treatment of lumbar degenerative disease remains ambiguous. The aim of this study was to evaluate perioperative serum albumin in relation to postoperative wound complications after posterior lumbar interbody fusion in the treatment of single-segment lumbar degenerative disease. Material and methods: We reviewed patients who underwent single-segment posterior lumbar interbody fusion surgery from December 2014 to April 2017 in the Department of Orthopedics at the First Affiliated Hospital of Chongqing Medical University. Perioperative (preoperative and early postoperative) serum albumin levels were assessed in all patients and were used to quantify nutritional status. We divided the patients into a surgical wound dehiscence (SWD) group and a normal wound healing group, and into a surgical site infection (SSI) group and a non-SSI group. To evaluate the relationship between perioperative serum albumin level and postoperative wound complications, we conducted univariate and multiple logistic regression analyses.Results: A total of 554 patients were enrolled in the study. The univariate and multiple logistic regression analysis of these differences showed that preoperative serum albumin <3.5 g/dl (P =0.001) and postoperative serum albumin <3.0 g/dl (P =0.001) were significantly correlated to SWD. There were also significant differences between the SSI groups in terms of preoperative serum albumin <3.5 g/dl (P=0.001), Chronic steroid use (P=0.003). Additionally, the increased hospitalization costs (P<0.001) and length of hospitalization (P<0.001) were statistically significant for patients with perioperative hypoalbuminemia. Conclusions: For patients who underwent single-segment posterior lumbar interbody fusion surgery, we need to pay more attention to perioperative hypoalbuminemia and chronic steroid use,which are more likely to be associated with increased wound complications, hospitalization costs and length of hospitalization after surgery. Adequate assessment and management of these risk factors will help reduce wound complications and hospital stays for surgical patients and will save medical costs.

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“…Yi et al retrospectively analyzed patients who underwent aseptic revision total joint arthroplasties (TJAs) and reported that malnutrition, as evaluated by serum albumin, TLC, or transferrin, was independently associated with chronic PJI and acute postoperative infections. Patients with hypoalbuminemia were found to have higher rates of postoperative infections following aseptic revision TJAs in a study of patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) registry . A similar study of patients who underwent primary total hip and knee arthroplasties found an association between hypoalbuminemia and surgical site infection, pneumonia, extended length of stay, and readmissions .…”

Section: Discussionmentioning

confidence: 99%

“…Malnutrition has been identified as a risk factor of postoperative infection and wound complications in total hip and knee arthroplasty. 8,9 When this was addressed with nutritional supplementation in patients undergoing abdominal surgery or operative fixation of hip fractures, the rate of postoperative complications decreased. 10,11 No studies have shown this relationship in patients undergoing limb salvage surgery.…”

Section: Introductionmentioning

confidence: 99%

Is malnutrition associated with postoperative complications in patients with primary bone sarcomas?

Park

Lans

Raskin

et al. 2018

Journal of Surgical Oncology

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Background Modifiable risk factors that can be optimized to minimize postoperative complications in patients with bone sarcomas are yet to be identified. Methods We retrospectively identified 275 patients aged 18 and older who underwent surgery for primary bone sarcomas who also had albumin values recorded within 4 weeks before surgery. Postoperative complications were defined as infection, hematoma, need for additional surgery, or wound complications. Results In the multivariate analysis, age (P = 0.049) and neoadjuvant radiotherapy (P = 0.008) were independently associated with postoperative complications. We then performed a subanalysis of patients without a pelvic tumor who also did not receive radiotherapy (n = 178). In this population, albumin less than 2.8 g/dL was found to be independently associated with postoperative complications (odds ratio [OR], 4.69. 95% confidence intervals [CI], 1.03‐21.97; P = 0.046). Conclusions This study demonstrates that hypoalbuminemia (albumin < 2.8 g/dL) is associated with postoperative complications in patients with nonpelvic bone sarcomas who do not receive radiation. Future studies are necessary to further elucidate the role of nutrition, and they may show that nutritional status is a modifiable risk factor that can be optimized to improve the outcome of surgery for primary bone sarcomas.

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Is Hypoalbuminemia Associated With Septic Failure and Acute Infection After Revision Total Joint Arthroplasty? A Study of 4517 Patients From the National Surgical Quality Improvement Program

Cited by 102 publications

References 21 publications

Serum Globulin and Albumin to Globulin Ratio as Potential Diagnostic Biomarkers for Periprosthetic Joint Infection: A Retrospective Review

Serum Globulin and Albumin to Globulin Ratio as Potential Diagnostic Biomarkers for Periprosthetic Joint Infection: A Retrospective Review

Perioperative Hypoalbuminemia is a Risk Factor for Wound Complications Following Posterior Lumbar Interbody Fusion

Is malnutrition associated with postoperative complications in patients with primary bone sarcomas?

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