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J Hand Microsurg 2020; 12(S 01): S33-S38
DOI: 10.1055/s-0039-3400433
Original Article

The Impact of Malnutrition on 30-Day Postoperative Complications following Surgical Fixation of Distal Radius Fractures

Jared M. Newman
1   Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States
,
Marine Coste
1   Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States
,
Karan Dua
1   Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States
,
Andrew Yang
1   Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States
,
Frank S. Cautela
1   Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States
,
Neil V. Shah
1   Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States
,
Aakash M. Patel
2   Department of Orthopaedic Surgery, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois, United States
,
Alexander Chee
1   Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States
,
Anton Khlopas
3   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, United States
,
Steven M. Koehler
1   Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States
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Abstract

Introduction Distal radius fractures (DRFs) are increasingly managed surgically among fragility fractures due to prolonged life expectancy and surgical advancements. Yet, malnutrition can impact postoperative outcomes and complications. We sought to determine the impact of malnutrition on open reduction and internal fixation (ORIF) of DRFs during the perioperative and 30-day postoperative periods.

Materials and Methods Using the National Surgical Quality Improvement Program database, all patients who underwent ORIF of a DRF between January 1, 2008, and December 31, 2016, were identified and stratified by preoperative serum albumin levels: normal (≥3.5 g/dL; n = 2,546) or hypoalbuminemia (<3.5 g/dL; n = 439). Demographical and perioperative data were compared. Operative complications were stratified into major and minor complications, and data were analyzed using descriptive statistics and multivariate regression models.

Results Compared with patients with normal levels, a higher proportion of hypoalbuminemia patients had ASA scores > 3 (9.1 vs. 2%) and a longer mean length of stay (3.16 vs. 0.83 days). Hypoalbuminemia patients also had 625% greater odds for developing major complications during the 30-day postoperative period (odds ratio = 7.25; 95% confidence interval: 1.91–27.49).

Conclusion Malnutrition significantly affected outcomes and complications of distal radius ORIF. This study highlights the importance of prevention and treatment of malnutrition in the setting of fragility fractures.

Keywords

distal radius fracture - fragility - hypoalbuminemia - malnutrition - open reduction internal fixation - complications - surgical fixation


Publication History

Article published online:
16 January 2020

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  • References

  • 1 MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther 2016; 29 (02) 136-145
    CrossrefPubMedGoogle Scholar
  • 2 Holroyd C, Harvey N, Dennison E, Cooper C. Epigenetic influences in the developmental origins of osteoporosis. Osteoporos Int 2012; 23 (02) 401-410
    CrossrefPubMedGoogle Scholar
  • 3 Shauver MJ, Yin H, Banerjee M, Chung KC. Current and future national costs to medicare for the treatment of distal radius fracture in the elderly. J Hand Surg Am 2011; 36 (08) 1282-1287
    CrossrefPubMedGoogle Scholar
  • 4 Arora R, Gabl M, Erhart S, Schmidle G, Dallapozza C, Lutz M. Aspects of current management of distal radius fractures in the elderly individuals. Geriatr Orthop Surg Rehabil 2011; 2 (5-6) 187-194
    CrossrefPubMedGoogle Scholar
  • 5 Egol KA, Walsh M, Romo-Cardoso S. Dorsky S, Paksima N. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am 2010; 92 (09) 1851-1857
    CrossrefPubMedGoogle Scholar
  • 6 Kamath AF, McAuliffe CL, Kosseim LM, Pio F, Hume E. Malnutrition in joint arthroplasty: prospective study indicates risk of unplanned ICU admission. Arch Bone Jt Surg 2016; 4 (02) 128-131
    Google Scholar
  • 7 Lee NJ, Kothari P, Kim JS. et al. Nutritional status as an adjunct risk factor for early postoperative complications following posterior cervical fusion. Spine 2017; 42 (18) 1367-1374
    CrossrefPubMedGoogle Scholar
  • 8 Nelson CL, Elkassabany NM, Kamath AF, Liu J. Low albumin levels, more than morbid obesity, are associated with complications after TKA. Clin Orthop Relat Res 2015; 473 (10) 3163-3172
    CrossrefPubMedGoogle Scholar
  • 9 Cross MB, Yi PH, Thomas CF, Garcia J, Della Valle CJ. Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg 2014; 22 (03) 193-199
    CrossrefPubMedGoogle Scholar
  • 10 Cabrerizo S, Cuadras D, Gomez-Busto F, Artaza-Artabe I, Marín-Ciancas F, Malafarina V. Serum albumin and health in older people: review and meta analysis. Maturitas 2015; 81 (01) 17-27
    CrossrefPubMedGoogle Scholar
  • 11 Caironi P, Langer T, Gattinoni L. Albumin in critically ill patients: the ideal colloid?. Curr Opin Crit Care 2015; 21 (04) 302-308
    CrossrefPubMedGoogle Scholar
  • 12 Vincent J-L, Dubois M-J, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg 2003; 237 (03) 319-334
    CrossrefPubMedGoogle Scholar
  • 13 Sullivan DH, Sun S, Walls RC. Protein-energy undernutrition among elderly hospitalized patients: a prospective study. JAMA 1999; 281 (21) 2013-2019
    CrossrefPubMedGoogle Scholar
  • 14 Seiler WO. Clinical pictures of malnutrition in ill elderly subjects. Nutrition 2001; 17 (06) 496-498
    CrossrefPubMedGoogle Scholar
  • 15 O’Daly BJ, Walsh JC, Quinlan JF. et al. Serum albumin and total lymphocyte count as predictors of outcome in hip fractures. Clin Nutr 2010; 29 (01) 89-93
    CrossrefPubMedGoogle Scholar
  • 16 Patterson BM, Cornell CN, Carbone B, Levine B, Chapman D. Protein depletion and metabolic stress in elderly patients who have a fracture of the hip. J Bone Joint Surg Am 1992; 74 (02) 251-260
    CrossrefPubMedGoogle Scholar
  • 17 Hanger HC, Smart EJ, Merrilees MJ, Frampton CM. The prevalence of malnutrition in elderly hip fracture patients. N Z Med J 1999; 112 (1084) 88-90
    PubMedGoogle Scholar
  • 18 Nicholson JA, Dowrick AS, Liew SM. Nutritional status and short-term outcome of hip arthroplasty. J Orthop Surg (Hong Kong) 2012; 20 (03) 331-335
    CrossrefPubMedGoogle Scholar
  • 19 Bohl DD, Shen MR, Kayupov E, Cvetanovich GL, Della Valle CJ. Is hypoalbuminemia associated with septic failure and acute infection after revision total joint arthroplasty? A study of 4517 patients from the National Surgical Quality Improvement Program. J Arthroplasty 2016; 31 (05) 963-967
    CrossrefPubMedGoogle Scholar
  • 20 Dietch ZC, Guidry CA, Davies SW, Sawyer RG. Hypoalbuminemia is disproportionately associated with adverse outcomes in obese elective surgical patients. Surg Obes Relat Dis 2015; 11 (04) 912-918
    CrossrefPubMedGoogle Scholar
  • 21 Phan K, Kim JS, Xu J. et al. Nutritional insufficiency as a predictor for adverse outcomes in adult spinal deformity surgery. Global Spine J 2018; 8 (02) 164-171
    CrossrefPubMedGoogle Scholar
  • 22 Afshinnia F, Wong KK, Sundaram B, Ackermann RJ, Pennathur S. Hypoalbuminemia and osteoporosis: reappraisal of a controversy. J Clin Endocrinol Metab 2016; 101 (01) 167-175
    CrossrefPubMedGoogle Scholar
  • 23 American College of Surgeons. National Surgical Quality Improvement Program. Participant use data file
  • 24 Khuri SF, Daley J, Henderson W. et al. National VA Surgical Quality Improvement Program. The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. Ann Surg 1998; 228 (04) 491-507
    Google Scholar
  • 25 Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg 2009; 250 (03) 363-376
    CrossrefPubMedGoogle Scholar
  • 26 Shiloach M, Frencher SK Jr, Steeger JE. et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2010; 210 (01) 6-16
    Google Scholar
  • 27 Bovonratwet P, Malpani R, Ottesen TD. et al. Aseptic revision total hip arthroplasty in the elderly: quantifying the risks for patients over 80 years old. Bone Joint J 2018; 100-B (02) 143-151
    CrossrefPubMedGoogle Scholar
  • 28 Curtis GL, Newman JM, George J, Klika AK, Barsoum WK, Higuera CA. Perioperative outcomes and complications in patients with heart failure following total knee arthroplasty. J Arthroplasty 2018; 33 (01) 36-40
    CrossrefPubMedGoogle Scholar
  • 29 Lukasiewicz AM, Grant RA, Basques BA, Webb ML, Samuel AM, Grauer JN. Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program. J Neurosurg 2016; 124 (03) 760-766
    CrossrefPubMedGoogle Scholar
  • 30 Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol 2008; 61 (12) 1234-1240
    CrossrefPubMedGoogle Scholar
  • 31 Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004; 57 (12) 1288-1294
    CrossrefPubMedGoogle Scholar
  • 32 Stavem K, Hoel H, Skjaker SA, Haagensen R. Charlson comorbidity index derived from chart review or administrative data: agreement and prediction of mortality in intensive care patients. Clin Epidemiol 2017; 9: 311-320
    CrossrefPubMedGoogle Scholar
  • 33 Higuera CA, Elsharkawy K, Klika AK, Brocone M, Barsoum WK. 2010 Mid-America Orthopaedic Association Physician in Training Award: predictors of early adverse outcomes after knee and hip arthroplasty in geriatric patients. Clin Orthop Relat Res 2011; 469 (05) 1391-1400
    CrossrefPubMedGoogle Scholar
  • 34 Belmont Jr PJ, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ. Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am 2014; 96 (01) 20-26
    CrossrefPubMedGoogle Scholar
  • 35 Gallagher-Allred CR, Voss AC, Finn SC. McCamish MA. Malnutrition and clinical outcomes: the case for medical nutrition therapy. J Am Diet Assoc 1996; 96 (04) 361-366
    CrossrefPubMedGoogle Scholar
  • 36 Radman M, Mack R, Barnoya J. et al. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Surg 2014; 147 (01) 442-450
    CrossrefPubMedGoogle Scholar
  • 37 Chermesh I, Hajos J, Mashiach T. et al. Malnutrition in cardiac surgery: food for thought. Eur J Prev Cardiol 2014; 21 (04) 475-483
    CrossrefPubMedGoogle Scholar
  • 38 La Torre M, Ziparo V, Nigri G, Cavallini M, Balducci G, Ramacciato G. Malnutrition and pancreatic surgery: prevalence and outcomes. J Surg Oncol 2013; 107 (07) 702-708
    CrossrefPubMedGoogle Scholar
  • 39 Leandro-Merhi VA, de Aquino JLB. Determinants of malnutrition and post-operative complications in hospitalized surgical patients. J Health Popul Nutr 2014; 32 (03) 400-410
    PubMedGoogle Scholar
  • 40 Sikorska D, Olewicz-Gawlik A, Baum E. Pawlaczyk K, Oko A. The importance of hypoalbuminemia in peritoneal dialysis patients: impact of gender. Adv Clin Exp Med 2019; 28 (06) 729-735
    CrossrefPubMedGoogle Scholar
  • 41 American College of Surgeons. ACS NSQIP User Guide. National Surgical Quality Improvement Program (NSQIP)
  • 42 Lee JH, Hutzler LH, Shulman BS, Karia RJ, Egol KA. Does risk for malnutrition in patients presenting with fractures predict lower quality measures?. J Orthop Trauma 2015; 29 (08) 373-378
    CrossrefPubMedGoogle Scholar
  • 43 Day SM, DeHeer DH. Reversal of the detrimental effects of chronic protein malnutrition on long bone fracture healing. J Orthop Trauma 2001; 15 (01) 47-53
    CrossrefPubMedGoogle Scholar
  • 44 Kumar V, Alva A, Akkena S, Jones M, Murphy PN, Clough T. Are albumin and total lymphocyte count significant and reliable predictors of mortality in fractured neck of femur patients?. Eur J Orthop Surg Traumatol 2014; 24 (07) 1193-1196
    CrossrefPubMedGoogle Scholar
  • 45 Steinberg EL, Amar E, Sagy Y, Rath E, Kadar A, Sternheim A. The impact of serum albumin and serum protein levels on POSSUM score of patients with proximal femur fractures. Injury 2014; 45 (12) 1928-1931
    CrossrefPubMedGoogle Scholar
  • 46 Kieffer WKMM, Rennie CS, Gandhe AJ. Preoperative albumin as a predictor of one-year mortality in patients with fractured neck of femur. Ann R Coll Surg Engl 2013; 95 (01) 26-28
    CrossrefPubMedGoogle Scholar
  • 47 Nakano T, Kuwabara A, Tanaka K. Overestimated serum albumin levels in patients with hip fracture. Clin Nutr 2011; 30 (02) 261-262
    CrossrefPubMedGoogle Scholar
  • 48 Myint MWW, Wu J, Wong E. et al. Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. Age Ageing 2013; 42 (01) 39-45
    CrossrefPubMedGoogle Scholar
  • 49 Langsetmo L, Shikany JM, Burghardt AJ. et al; Osteoporotic Fractures in Men (MrOS) Study Research Group. High dairy protein intake is associated with greater bone strength parameters at the distal radius and tibia in older men: a cross-sectional study. Osteoporos Int 2018; 29 (01) 69-77
    CrossrefPubMedGoogle Scholar
  • 50 NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA 2001; 285 (06) 785-795
    CrossrefPubMedGoogle Scholar
  • 51 Wilson JM, Holzgrefe RE, Staley CA, Schenker ML, Meals C. The effect of malnutrition on postoperative complications following surgery for distal radius fractures. J Hand Surg Am 2019; 44 (09) 742-750
    CrossrefPubMedGoogle Scholar
  • 52 Luchetti TJ, Chung A, Olmscheid N, Bohl DD, Hustedt JW. Hypoalbuminemia is associated with increased postoperative mortality and complications in hand surgery. Hand (N Y) 2019