Relationship Between Preoperative Nutritional Status and Predicting Short-Term Complications Following Revision Total Hip Arthroplasty

Heimroth, Jamie; Neufeld, Eric V.; Sodhi, Nipun; Walden, Timothy; Willinger, Max L.; Boraiah, Sreevathsa

doi:10.1016/j.arth.2023.02.077

Cited by 4 publications

(2 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several patient populations have been shown to be at risk for malnutrition. Both underweight (BMI of <18.5 kg/m 2 ) 34 and obese (BMI >30 kg/m 2 ) 35 patients are at increased risk for malnutrition. Furthermore, patients with a history of weight-loss surgery, diabetes, or chronic gastrointestinal disease are at risk for malnutrition.…”

Section: Discussionmentioning

confidence: 99%

Nutritional Laboratory Studies Prior to Total Knee Arthroplasty

Rakutt,

Eason,

Boyle

et al. 2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: Recent emphasis has been placed on nutritional status assessment prior to total knee arthroplasty (TKA), including multiple American Academy of Orthopaedic Surgeons publications recommending specific laboratory studies; however, the frequency with which surgeons obtain these laboratory studies remains unclear. We sought to assess the incidence of ordering nutritional laboratory studies in the 90 days prior to TKA, utilizing data from a large administrative claims database. Methods: With use of the PearlDiver database, we identified 557,670 patients undergoing primary TKA from 2011 to 2020 with a metabolic panel or blood cell count claim within 90 days prior to TKA. We then determined the incidence of prealbumin, transferrin, vitamin D, and zinc laboratory tests claimed 90 days prior to TKA. Associations between claims and the year of surgery, patient demographics, and clinical characteristics were assessed by comparing proportions and chi-square testing. Results: Nutritional laboratory studies were infrequently claimed within 90 days prior to TKA, with studies for prealbumin being performed in 2.2% of patients; transferrin, 1.9%; vitamin D, 10.2%; and zinc, 0.2%. From 2011 to 2020, there was a moderate but steady increase in the proportion of patients with claims for prealbumin (change from 0.8% in 2011 to 3.4% in 2020; p < 0.001), transferrin (0.8% to 2.7%; p < 0.001), and vitamin D (7.6% to 9.4%; p < 0.001) laboratory tests but there was less of a change for zinc (0.1% to 0.2%; p < 0.001). There were weak-to-absent associations of age, gender, obesity, diabetes, and anemia with laboratory claims. Conclusions: Despite multiple publications and recommendations, nutritional laboratory studies are infrequently ordered prior to TKA. Although there has been a slight increase in the use of nutritional laboratory studies over the past decade, patient factors such as gender and obesity were not associated with this increase. Understanding current practice patterns may help target future areas for improvement. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Section: Discussionmentioning

confidence: 99%

Nutritional Laboratory Studies Prior to Total Knee Arthroplasty

Rakutt,

Eason,

Boyle

et al. 2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

show abstract

“…The incredible amount of historical data that lacks the information necessary for a correct diagnosis can nonetheless count on a set of non-diagnostic indicators each with its own drawbacks (Table 2) but having in common the fact that they couple at least two surrogate variables of nutritional interest. It is not meaningless to use a single laboratory analyte as an indicator of nutritional status, since they have long been used by themselves (especially albumin and hemoglobin) (21), and still provide remarkable findings in today's orthopedic surgery research (24,25). However, it is necessary to distinguish that risk screening and diagnosis are two distinct evaluations but part of the same two-step process.…”

Section: Or ↓Mchcmentioning

confidence: 99%

Definition of malnutrition from routinely-collected data for orthopedic surgery research: the global leadership initiative on malnutrition (GLIM) tool and others

Briguglio,

Wainwright,

Lombardi

2023

Front. Nutr.

View full text Add to dashboard Cite

The correct identification of malnourished patients in the context of hip, knee, or spine surgery research would enhance the quality of analytical studies investigating the prediction potential of preoperative nutritional disorders on postoperative recovery. However, accurate malnutrition screening and diagnostic assessment rely on parameters that were not routinely collected in routine practice until a few years ago. The authors of this article present substitute literature-based equations that can be built up using historical routinely collected data to classify patients that had been at risk of malnutrition or malnourished. For what concerns the risk screening, several methods are available to identify patients at risk of over- or undernutrition, encompassing the BWd (body weight difference from the ideal weight), GNRI (geriatric nutritional risk index), INA (instant nutritional assessment), LxA (combination of lymphocyte count and albumin), PMA (protein malnutrition with acute inflammation), PMAC (protein malnutrition with acute and chronic inflammation), IDM (iron deficit malnutrition), and VBD (vitamin B deficit malnutrition). Conversely, the GLIM (global leadership initiative on malnutrition) criteria can be used to assess malnutrition and diagnose subclasses of undernutrition. Rational use of these tools can facilitate the conduction of efficient prospective studies in the future, as well as bespoke retrospective cohort studies and database research.

show abstract