Low Preoperative Albumin Associated With Increased Risk of Superficial Surgical Site Infection Following Midfoot, Hindfoot, and Ankle Fusion

Abstract

Background This study investigates the effect of malnutrition, defined by hypoalbuminemia, on rates of complication, readmission, reoperation, and mortality following midfoot, hindfoot, or ankle fusion. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 to 2019 to identify 500 patients who underwent midfoot (n = 233), hindfoot (n = 261), or ankle (n = 117) fusion. Patients were stratified into normal (n = 452) or low (n = 48) albumin group, which was defined by preoperative serum albumin level <3.5 g/dL. Demographics, medical comorbidities, hospital length of stay (LOS), and 30-day complication, readmission, and reoperation rates were compared between groups. The mean age of the cohort was 58.7 (range, 21-89) years. Results Hypoalbuminemia patients were significantly more likely to have diabetes (P < .001), be on dialysis (P < .001), and be functionally dependent (P < .001). The LOS was significantly greater among the low albumin group (P < .001). The hypoalbuminemia cohort also exhibited a significantly increased likelihood of superficial infection (P = .048). Readmission (P = .389) and reoperation (P = .611) rates did not differ between the groups. Conclusion This study shows that malnourished patients have an increased risk of superficial infection following foot and ankle fusions but are not at an increased risk of readmission or reoperation, suggesting that low albumin confers an elevated risk of surgical site infection. Levels of Evidence: Level III, Retrospective cohort study

The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery

“…Notably, in a study evaluating lower extremity fractures in patients younger than 65 years, ankle and pilon fractures were the second most common fracture type among the malnourished, frail, and malnourished plus frail cohorts (hip fractures ranked first) 13 . Hypoalbuminemia is reported to significantly increase the risk of SSI and hospital LOS in ankle ORIF, calcaneus ORIF, foot/ankle arthrodesis, and Achilles tendon repair in all except one study, which lost significance for SSI in ankle ORIF after multivariate analysis 5,24,159-161 . Kisana et al attempted to create a scoring system for predicting surgical complications in foot and ankle surgery in which hypoalbuminemia is the second highest scoring risk factor behind anemia, highlighting the importance of nutritional optimization in this field 162 .…”