Patient Optimization—Strategies That Work: Malnutrition

Golladay, Gregory J.; Satpathy, Jibanananda; Jiranek, William A.

doi:10.1016/j.arth.2016.03.027

Cited by 59 publications

(53 citation statements)

References 51 publications

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“…Albumin was found to be the most commonly utilized, similar to previous studies. 4,24,25,27 Our data also showed that a low serum albumin (<3.5 g/dL) was found to be associated with increased postoperative infection and wound complication rates. In contrast to our study, a previous prospective study comprised 40 patients (33 hips and 7 knees) undergoing total joint replacement, and found no correlation between low preoperative serum albumin and wound healing.…”

Section: Discussionsupporting

confidence: 65%

“…16,[21][22][23] Furthermore, the use of laboratory screening values has not been well defined. [24][25][26] Therefore, this study aimed to determine the rate of postoperative infections, wound complications, CoIW, and wound complications following infection by using albumin, prealbumin, and transferrin values as indicators of nutritional status. The primary findings of our study determined that all adverse outcomes were increased in those with preoperative albumin <3.5 g/dL, prealbumin <15 mg/dL, and transferrin < 200 mg/dL values falling below the normal range.…”

Section: Discussionmentioning

confidence: 99%

“…Golladay et al suggest utilizing a combination of nutritional interventions that include supplementing protein, iron, vitamin D, vitamin C, and zinc sulfate with follow-up at 6 to 12 weeks to reassess nutritional status prior to elective joint procedures. 24 Baer instituted a postoperative protein supplement program in 180 obese arthroplasty patients and found encouraging results with two protein shakes per day. After 60 days of treatment, average values increased from 10.4 and 9.6 in men and women, respectively, to 18.6 and 21.4.…”

Section: Discussionmentioning

confidence: 99%

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Albumin, Prealbumin, and Transferrin May Be Predictive of Wound Complications following Total Knee Arthroplasty

et al. 2018

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Nutritional status has become increasingly important in optimizing surgical outcomes and preventing postoperative infection and wound complications. However, currently, there is a paucity in the orthopaedics literature investigating the relationship between nutritional status and wound complications following total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine the prevalence of (1) postoperative infections, (2) wound complications, (3) concomitant infection with wound (CoIW) complication, and (4) infection followed by wound complication by using (1) albumin, (2) prealbumin, and (3) transferrin levels as indicators of nutritional status. These four different outcome measures were chosen as they are encountered commonly in daily clinical practice. A retrospective review of a national private payer database for patients who underwent TKA with postoperative infections and wound complications stratified by preoperative serum albumin (normal: 3.5–5 g/dL), prealbumin (normal: 16–35 mg/dL), and transferrin levels (normal: 200–360 mg/dL) between 2007 and 2015 was conducted. Patients were identified by Current Procedural Terminology (CPT), International Classification of Disease, ninth revision (ICD-9) codes, and Logical Observation Identifiers Names and Codes (LOINC). Linear regression was performed to evaluate changes over times. Yearly rates of infection, as well as a correlation and odds ratio analysis of nutritional laboratory values to postoperative complications, were also performed. Our query returned a total of 161,625 TKAs, of which 11,047 (7%) had postoperative wound complications, 18,403 (11%) had infections, 6,296 (34%) had CoIW, and 4,877 (4%) patients with infection developed wound complications. Albumin was the most commonly ordered laboratory test when assessing complications (96%). Wound complications, infections, CoIW, and infection with wound complications after were higher in those below the normal range: albumin <3.5 g/dL (9, 14, 6, and 5%), prealbumin <15 mg/dL (20, 23, 13, and 12%), and transferrin <200 mg/dL (12, 17, 6, and 6%). Preoperative albumin, prealbumin, and transferrin values falling below the normal range represented an increased risk for postoperative complications. Those patients who were in the normal range, however, did not have an increased risk. Therefore, our results suggest that preoperative nutritional optimization can play an important role in reducing the risk for postoperative complications.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Albumin, Prealbumin, and Transferrin May Be Predictive of Wound Complications following Total Knee Arthroplasty

et al. 2018

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“…With this armamentarium of screening tools, surgeons can make use of a variety of therapies to optimize nutritional status preoperatively with the help of primary care providers. Enteral supplementation, including protein nutritional shakes, multivitamins, and iron supplementation, are simple interventions that may help support wound healing in the postoperative period [32] .…”

Section: Patient Optimizationmentioning

confidence: 99%

Prediction of surgical complications in the elderly: Can we improve outcomes?

Mistry

Gaunay

Hoenig

2017

Asian Journal of Urology

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As the number of Americans aged 65 years and older continues to rise, there is projected to be a corresponding increase in demand for major surgeries within this population. Consequently, it is important to utilize accurate preoperative risk stratification techniques that are applicable to elderly individuals. Currently, commonly used preoperative risk assessments are subjective and often do not account for elderly-specific syndromes that may pose a hazard for geriatric patients if not addressed. Failure to accurately risk-stratify these patients may increase the risk of postoperative complications, morbidity, and mortality. Therefore, we aimed to identify and discuss the more objective and better-validated measurements indicative of poor surgical outcomes in the elderly with special focus on frailty, patient optimization, functional status, and cognitive ability.

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“…The patient comorbidities of obesity [39][40][41][42][43] and psychiatric disorders 44 were associated with increased risk of PJI. Additionally, hypoalbuminemia was associated with increased PJI risk due to poor wound-healing 45,46 , and improving nutritional parameters, such as albumin, iron, protein, transferrin, vitamin D, and zinc, can reduce the risk of infection 47 . Finally, patient use of prophylactic anticoagulants, such as rivaroxaban, resulted in a 12.5-fold increased likelihood for infection, compared with other forms of chemoprophylaxis for venous thromboembolism prevention 48 .…”

Section: Shoulder and Elbowmentioning

confidence: 99%