Journal article
Hypoalbuminemia Is an Independent Risk Factor for 30-Day Mortality, Postoperative Complications, Readmission, and Reoperation in the Operative Lower Extremity Orthopaedic Trauma Patient
Journal of orthopaedic trauma, Vol.33(6), pp.284-291
06/01/2019
DOI: 10.1097/BOT.0000000000001448
PMID: 30720559
Abstract
Introduction: Malnutrition, as indicated by hypoalbuminemia, is known to have detrimental effects on outcomes after arthroplasty, geriatric hip fractures, and multiple general surgeries. Hypoalbuminemia has been examined in the critically ill but has largely been ignored in the orthopaedic trauma literature. We hypothesized that admission albumin levels would correlate with postoperative course in the nongeriatric lower extremity trauma patient.
Methods: Patients with lower extremity (including pelvis and acetabulum) fracture who underwent operative intervention were collected from the ACS-NSQIP database. Patients younger than 65 years were included. Patient demographic data, complications, length of stay, reoperation rate, and readmission rate were collected, and patient modified frailty index scores were calculated. Poisson regression with robust error variance was then conducted, controlling for potential confounders.
Results: Five thousand six hundred seventy-three patients with albumin available were identified, and 29.6% had hypoalbuminemia. Hypoalbuminemic patients had higher rates of postoperative complications [9.3% vs. 2.6%; relative risk (RR) 1.63] including increased rates of: mortality (3.2% vs. 0.4%; RR 4.86, 95% confidence interval 2.66-8.87), sepsis (1.5% vs. 0.5%, RR 2.35), and reintubation (2.3% vs. 0.4%; RR 3.84). Reoperation (5.5% vs. 2.6%, RR 1.74) and readmission (11.4% vs. 4.1%; RR 2.53) rates were also higher in patients with low albumin.
Conclusion: Hypoalbuminemia is a powerful predictor of acute postoperative course and mortality after surgical fixation in nongeriatric, lower extremity orthopaedic trauma patients. Admission albumin should be a routine part of the orthopaedic trauma workup. Further study into the utility of supplementation is warranted, as this may represent a modifiable risk factor.
Details
- Title: Subtitle
- Hypoalbuminemia Is an Independent Risk Factor for 30-Day Mortality, Postoperative Complications, Readmission, and Reoperation in the Operative Lower Extremity Orthopaedic Trauma Patient
- Creators
- Jacob M. Wilson - Emory UniversityMatthew P. Lunati - Emory Univ, Dept Orthopaed Surg, Sch Med, 59 Execut Pk South, Atlanta, GA 30329 USAZachary J. Grabel - Emory Univ, Dept Orthopaed Surg, Sch Med, 59 Execut Pk South, Atlanta, GA 30329 USAChristopher A. Staley - Emory UniversityAndrew M. Schwartz - Emory UniversityMara L. Schenker - Emory University
- Resource Type
- Journal article
- Publication Details
- Journal of orthopaedic trauma, Vol.33(6), pp.284-291
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/BOT.0000000000001448
- PMID
- 30720559
- ISSN
- 0890-5339
- eISSN
- 1531-2291
- Number of pages
- 8
- Language
- English
- Date published
- 06/01/2019
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984304696202771
Metrics
10 Record Views