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Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery.
J Orthop Trauma. 2018 04; 32(4):155-160.JO

Abstract

OBJECTIVES

Low serum albumin levels (hypoalbuminemia) have classically been used to identify malnutrition. The effect of increasing severity of malnutrition on postoperative outcomes in patients undergoing hip fracture surgery has not been well delineated on a large scale.

DESIGN

Retrospective.

SETTING

Multicenter.

PATIENT/PARTICIPANTS

A total of 12,373 patients undergoing hip fracture surgery from 2006 to 2013 National Surgery Quality Improvement Project data were identified.

INTERVENTION

Patient demographic, comorbidity, and preoperative laboratory data and complication, reoperation, and readmission data were collected.

MAIN OUTCOME MEASUREMENTS

Multivariate logistic regression was used to determine the effect of increasing severity of malnutrition on rates of 30-day postoperative complications, readmissions, and reoperations.

RESULTS

A total of 12,373 hip fractures met inclusion criteria. A total of 6506 (52.6%) patients had normal albumin levels (albumin ≥3.5 g/dL), 3205 (25.9%) patients were mildly malnourished (albumin 3.1-3.49 g/dL), 2265 (18.3%) were moderately malnourished (albumin 2.4-3.1 g/dL), and 397 (3.2%) patients were severely malnourished (albumin <2.4 g/dL). Mean age was similar between the 4 cohorts (P < 0.001). Severe malnutrition was associated with a 2-fold increase in the odds of postoperative complications and mortality when compared with mild malnutrition (P < 0.001). Increasing severity of malnutrition was associated with significantly longer lengths of stay and higher odds of experiencing a related readmission (P < 0.001).

CONCLUSIONS

Increasing severity of hypoalbuminemia is independently associated with poorer outcomes in the 30 days after hip fracture surgery.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Authors+Show Affiliations

Department of Orthopedic Surgery, Mayo Clinic-Arizona, Phoenix, AZ.Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ. The CORE Institute, Phoenix, AZ.Department of Orthopedics, University of Arizona College of Medicine-Tucson, Tucson, AZ.Department of Orthopedics, University of Mississippi, Jackson, MS.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

29558371

Citation

Chung, Andrew S., et al. "Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery." Journal of Orthopaedic Trauma, vol. 32, no. 4, 2018, pp. 155-160.
Chung AS, Hustedt JW, Walker R, et al. Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery. J Orthop Trauma. 2018;32(4):155-160.
Chung, A. S., Hustedt, J. W., Walker, R., Jones, C., Lowe, J., & Russell, G. V. (2018). Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery. Journal of Orthopaedic Trauma, 32(4), 155-160. https://doi.org/10.1097/BOT.0000000000001081
Chung AS, et al. Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery. J Orthop Trauma. 2018;32(4):155-160. PubMed PMID: 29558371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery. AU - Chung,Andrew S, AU - Hustedt,Joshua W, AU - Walker,Robert, AU - Jones,Clifford, AU - Lowe,Jason, AU - Russell,George V, PY - 2018/3/21/entrez PY - 2018/3/21/pubmed PY - 2019/8/20/medline SP - 155 EP - 160 JF - Journal of orthopaedic trauma JO - J Orthop Trauma VL - 32 IS - 4 N2 - OBJECTIVES: Low serum albumin levels (hypoalbuminemia) have classically been used to identify malnutrition. The effect of increasing severity of malnutrition on postoperative outcomes in patients undergoing hip fracture surgery has not been well delineated on a large scale. DESIGN: Retrospective. SETTING: Multicenter. PATIENT/PARTICIPANTS: A total of 12,373 patients undergoing hip fracture surgery from 2006 to 2013 National Surgery Quality Improvement Project data were identified. INTERVENTION: Patient demographic, comorbidity, and preoperative laboratory data and complication, reoperation, and readmission data were collected. MAIN OUTCOME MEASUREMENTS: Multivariate logistic regression was used to determine the effect of increasing severity of malnutrition on rates of 30-day postoperative complications, readmissions, and reoperations. RESULTS: A total of 12,373 hip fractures met inclusion criteria. A total of 6506 (52.6%) patients had normal albumin levels (albumin ≥3.5 g/dL), 3205 (25.9%) patients were mildly malnourished (albumin 3.1-3.49 g/dL), 2265 (18.3%) were moderately malnourished (albumin 2.4-3.1 g/dL), and 397 (3.2%) patients were severely malnourished (albumin <2.4 g/dL). Mean age was similar between the 4 cohorts (P < 0.001). Severe malnutrition was associated with a 2-fold increase in the odds of postoperative complications and mortality when compared with mild malnutrition (P < 0.001). Increasing severity of malnutrition was associated with significantly longer lengths of stay and higher odds of experiencing a related readmission (P < 0.001). CONCLUSIONS: Increasing severity of hypoalbuminemia is independently associated with poorer outcomes in the 30 days after hip fracture surgery. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. SN - 1531-2291 UR - https://www.unboundmedicine.com/medline/citation/29558371/Increasing_Severity_of_Malnutrition_Is_Associated_With_Poorer_30_Day_Outcomes_in_Patients_Undergoing_Hip_Fracture_Surgery_ L2 - http://dx.doi.org/10.1097/BOT.0000000000001081 DB - PRIME DP - Unbound Medicine ER -