Malnutrition as predictor of poor outcome after total hip arthroplasty
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ORIGINAL PAPER
Malnutrition as predictor of poor outcome after total hip arthroplasty Sandra Eminovic 1 & Gabor Vincze 1 Gerwin A. Bernhardt 1
&
Doris Eglseer 2 & Regina Riedl 3 & Patrick Sadoghi 1 & Andreas Leithner 1 &
Received: 12 November 2020 / Accepted: 18 November 2020 # The Author(s) 2020
Abstract Introduction The aim of this study was to assess the prevalence of protein energy malnutrition (PEM) and correlation with poor post-operative outcome in the elderly undergoing primary total hip arthroplasty (THA). Hypothesis Patients with PEM would have inferior post-operative outcome after THA. Materials and method We retrospectively evaluated the nutritional status of 220 hospitalized patients undergoing THA, 65 years and older. PEM was assessed using serum albumin and total lymphocyte count (TLC). Studied outcome parameters were length of pre-operative and post-operative stay, complications up to six months after surgery and 12-month mortality. Clinical and demographic data were retrieved from medical records from the hospital database. Results The prevalence of PEM among patients undergoing THA was 12.3% (27/220). Patients with PEM were significantly older (mean age 81.3 ± 7.0, p < 0.001), had a lower BMI (24.7 ± 4.1 kg/m 2, p = 0.022), and showed more comorbid conditions (mean CCI 2.8 ± 2.0, p = 0.002) compared with well-nourished patients (age 75.6 ± 6.2, BMI 26.8 ± 4.3 kg/m 2, CCI: 1.7 ± 1.7). Length of pre-operative stay differed significantly (p < 0.001) between PEM (median 7, range 1–36 days) and non PEM (median 1, range 1–22 days). In the PEM group, 12 (44.4%) patients had post-operative complications within six months after OP and 15 (7.8%) patients in the non PEM group (HR = 6.3, 95% CI 1.7–23.1). Conclusion We observed a higher post-operative complication rate for malnourished patients undergoing elective THA. These results underline the importance of pre-operative nutritional assessment in the elderly. Therefore, serum albumin and TLC are valuable clinical markers of PEM and the post-operative outcome. Keywords Malnutrition . PEM . Surgery . Total hip arthroplasty . Post-operative outcome
Abbreviations and acronyms PEM Protein energy malnutrition THA Total hip arthroplasty TLC Total lymphocyte count
* Gerwin A. Bernhardt [email protected] 1
Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
2
Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
3
Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
Introduction Osteoarthritis (OA) is one of the most common joint disorders in the elderly with a prevalence up to 45% in general population [1]. To alleviate the consequences of OA as pain or disability, total joint replacement (TJR) is commonly performed. One of the most often affected joints with OA is the hip requiring total hip arthroplasty (THA) in end stage osteoarthritis. Besides, elderly pat
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