Concomitant Malnutrition and Frailty Are Uncommon, but Significant Risk Factors for Mortality and Complication Following Primary Total Knee Arthroplasty

Andrew M Schwartz; Jacob M Wilson; Kevin X Farley; Thomas L. Bradbury Jr; George N. Guild III

doi:10.1016/j.arth.2020.05.062

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Concomitant Malnutrition and Frailty Are Uncommon, but Significant Risk Factors for Mortality and Complication Following Primary Total Knee Arthroplasty

Journal article

Peer reviewed

Concomitant Malnutrition and Frailty Are Uncommon, but Significant Risk Factors for Mortality and Complication Following Primary Total Knee Arthroplasty

Andrew M Schwartz, Jacob M Wilson, Kevin X Farley, Thomas L. Bradbury Jr and George N. Guild III

The Journal of arthroplasty, Vol.35(10), pp.2878-2885

10/2020

DOI: 10.1016/j.arth.2020.05.062

PMID: 32576431

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Abstract

Total knee arthroplasty (TKA) demand continues to rise, but we are also gaining greater insight into patient risk factors for postoperative complications and excess resource utilization. There has been growing interest in frailty and malnutrition as risk factors, although they are often mistakenly used interchangeably. We aimed at identifying the incidence of their coexistence, and the magnitude of risk they confer to TKA patients. We queried the American College of Surgeons-National Surgery Quality Improvement Program database to identify 4 patient cohorts: healthy/normal serum albumin, healthy/hypoalbuminemic patients, normoalbuminemic/medically frail patients (defined by modified frailty index), and hypoalbuminemic/frail patients. We performed both univariate and multivariate analyses to quantify the risk conferred by each condition in isolation, and in coexistence. Of 179,702 elective TKA cases from 2006 to 2018, 18.6% of patients were frail only, 3.0% were hypoalbuminemic -only, and just 1.2% were both frail and hypoalbuminemic. The raw rate of any complication was highest in frail/hypoalbuminemic patients (8.7%), 5.2% in hypoalbuminemic patients, 4.8% in frail patients, and just 3.4% in healthy patients (P < .001); the multivariate model revealed odds ratio of a complication in frail/hypoalbuminemic group of 2.40 (95% confidence interval = 1.27-1.63; P < .001). Mortality within 30 days was highest in the frail/hypoalbuminemic cohort (1.0%), and just 0.1% in healthy patients, and the multivariate model noted an odds ratio of 9.43 for these patients (95% confidence interval = 5.92-14.93; P < .001). The odds of all studied complications were highest in the frail/hypoalbuminemic group. Frailty and hypoalbuminemia represent distinct conditions and are independent risk factors for a complication after TKA. Their coexistence imparts a synergistic association with the risk of post-TKA complications.

Arthroplasty, Replacement, Knee - adverse effects

Frailty - complications

Frailty - epidemiology

Humans

Hypoalbuminemia - complications

Hypoalbuminemia - epidemiology

Malnutrition - complications

Malnutrition - epidemiology

Postoperative Complications - epidemiology

Postoperative Complications - etiology

Retrospective Studies

Risk Factors

Details

Title: Subtitle: Concomitant Malnutrition and Frailty Are Uncommon, but Significant Risk Factors for Mortality and Complication Following Primary Total Knee Arthroplasty
Creators: Andrew M Schwartz - Department of Orthopaedic Surgery, Atlanta, GA
Jacob M Wilson - Department of Orthopaedic Surgery, Atlanta, GA
Kevin X Farley - Department of Orthopaedic Surgery, Atlanta, GA
Thomas L. Bradbury Jr - Department of Orthopaedic Surgery, Atlanta, GA
George N. Guild III - Department of Orthopaedic Surgery, Atlanta, GA
Resource Type: Journal article
Publication Details: The Journal of arthroplasty, Vol.35(10), pp.2878-2885
DOI: 10.1016/j.arth.2020.05.062
PMID: 32576431
ISSN: 0883-5403
eISSN: 1532-8406
Language: English
Date published: 10/2020
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984303989602771

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