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

Abstract

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.

Factors associated with the length of stay in total knee arthroplasty patients with the enhanced recovery after surgery model

“…The preoperative albumin reflects the nutrition status of patients, which participates in the promotion of incision healing. A high pre-operative Alb could promote the incision healing, while a low serum Alb would lead to a variety of complications or even death [16,17]. Our study found that patients with preoperative Alb < 30 g/L had a longer LOS.…”

The financial burden of complications following rectal resection

“…Additionally, there is evidence to suggest that preoperative factors, including anemia and hypoalbuminemia, are associated with increased costs following surgery. [ 8 , 9 ]…”

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

“…But HAS use has been associated with higher risk of cardiac, pulmonary, and combined complications, acute renal failure, and unplanned intensive care unit admission [12]. Furthermore, hypoproteinemia was directly associated with increased total costs in revision and primary TJA [11]. Clinicians and policy providers should consider this question for optimizing the nutritional status of patients preoperatively and reducing the risk factors that may increase medical costs in the ear of bundled payments for TJA [20].…”

“…Similar to malnutrition, low serum albumin level is associated with various postoperative complications following TJA, which include pulmonary infection, renal impaired, super cial and deep infections, myocardial infarction, unplanned intubation, and even mortality [10]. Low serum albumin level is also related to increased treatment costs, longer length of stay, and higher risk of readmission [11].…”

“…Furthermore, HAS use is quite expensive, placing a substantial nancial burden on the health care systems [10]. One study [11] concluded that each 1 g/dL reduction in preoperative serum albumin increased direct costs of TJA on average by 1, 282 United States dollars.…”