Preoperative High-Protein Diet Can Improve The Serum Albumin Levels of Patients Undergoing Total Knee Arthroplasty

Abstract

Background: Preoperative hypoproteinemia are risk factors for complications in patients undergoing total knee arthroplasty (TKA). However, the relationship between preoperative albumin levels and postoperative use of albumin is unclear, as are the effects of a high-protein diet on preoperative serum albumin levels for these patients. Methods: We retrospectively enrolled 660 patients who underwent primary TKA from January to December 2019, of whom 97 received postoperative albumin and 563 did not. Logistic and restrictive cubic spline regression analyses were used to explore the relationship between preoperative serum albumin levels and postoperative albumin use. Additionally, 88 patients undergoing primary TKA were educated to follow a high-protein diet during the preoperative waiting period from January to July 2020. From these 88 patients, data from laboratory tests on the day of the outpatient visit and admission were collected and compared to evaluate the effect of high-protein diet on preoperative serum albumin levels. Results: Higher preoperative serum albumin levels were negatively associated with risk of postoperative albumin use (relative risk 0.725, 95% confidence interval 0.666-0.789), and the risk of needing postoperative albumin decreased with increasing preoperative albumin level with a negative dose-response relationship (P overall < 0.001; P nonlinear = 0.186). After an average of 39.05±22.78 days on a high-protein diet, the albumin levels on admission (46.04±2.49 g/L) were significantly higher than on outpatient (42.79±4.09) g/L), while the biomarkers of liver and kidney function and lipid metabolism did not differ significantly between the two time points. Conclusions: Preoperative albumin levels were highly associated with postoperative albumin use, showing an obvious dose-response relationship. Preoperative high-protein diet could improve the albumin levels in patients undergoing TKA. Trial registration: The study was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR2000034978) on July 26, 2020.