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The Effect of Malnutrition on Postoperative Complications Following Surgery for Distal Radius Fractures.
J Hand Surg Am. 2019 Sep; 44(9):742-750.JH

Abstract

PURPOSE

Malnutrition is known to negatively affect outcomes after arthroplasty, hip fracture, and spine surgery. Although distal radius fracture surgery may be considered in a similar patient cohort, the effect of malnutrition in this scenario is unknown. We hypothesized that admission serum albumin level, as a marker for malnutrition, would correlate with the rate of postoperative complications following surgery for distal radius fracture.

METHODS

We performed a retrospective cohort study of the American College of Surgeons National Surgery Quality Improvement database. Patients undergoing open reduction and internal fixation of a distal radius fracture were identified using Current Procedural Terminology codes. We excluded patients who were septic at presentation, were multiply injured, or had open fractures. We collected patient demographics, length of stay, 30-day complications, reoperation, and readmission rates. We performed multivariable linear regression analysis controlling for age, sex, body mass index, operative time, discharge destination, and modified Frailty Index score.

RESULTS

We identified 1,989 patients (mean age, 56 years; range, 18-90 years) with available albumin levels, and 14.7% had hypoalbuminemia (albumin, < 3.5 g/dL). Multivariable regression revealed that malnourished patients had higher rates of postoperative complications (6.5% vs 1.3%; odds ratio [OR] 4.88; 95% confidence interval [95% CI], 2.47-9.66). Specifically, these patients had increased rates of Clavien-Dindo IV (life-threatening) complications (2.4% vs 0%), readmission (7.2% vs 2%; OR, 3.37; 95% CI, 1.88-6.03), and mortality (1.7% vs 0.1%; OR, 9.23; 95% CI, 1.55-54.87). Malnourished patients had significantly longer length of stay (3.55 vs 0.73 days). Albumin concentration was inversely associated with risk of death (OR, 0.12; 95% CI, 0.03-0.52).

CONCLUSIONS

Malnutrition, indicated by albumin less than 3.5 g/dL, is a powerful predictor of uncommon, but important, postoperative complications, including mortality, following surgery for distal radius fracture. Evaluation of preoperative albumin level may, therefore, help surgeons provide individualized counseling and more accurately stratify the risk of patients.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Authors+Show Affiliations

Emory University Orthopedics and Spine, Atlanta, GA.Emory University Orthopedics and Spine, Atlanta, GA.Emory University Orthopedics and Spine, Atlanta, GA.Emory University Orthopedics and Spine, Atlanta, GA.Emory University Orthopedics and Spine, Atlanta, GA. Electronic address: clifton.meals@emory.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31300228

Citation

Wilson, Jacob M., et al. "The Effect of Malnutrition On Postoperative Complications Following Surgery for Distal Radius Fractures." The Journal of Hand Surgery, vol. 44, no. 9, 2019, pp. 742-750.
Wilson JM, Holzgrefe RE, Staley CA, et al. The Effect of Malnutrition on Postoperative Complications Following Surgery for Distal Radius Fractures. J Hand Surg Am. 2019;44(9):742-750.
Wilson, J. M., Holzgrefe, R. E., Staley, C. A., Schenker, M. L., & Meals, C. (2019). The Effect of Malnutrition on Postoperative Complications Following Surgery for Distal Radius Fractures. The Journal of Hand Surgery, 44(9), 742-750. https://doi.org/10.1016/j.jhsa.2019.05.004
Wilson JM, et al. The Effect of Malnutrition On Postoperative Complications Following Surgery for Distal Radius Fractures. J Hand Surg Am. 2019;44(9):742-750. PubMed PMID: 31300228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Effect of Malnutrition on Postoperative Complications Following Surgery for Distal Radius Fractures. AU - Wilson,Jacob M, AU - Holzgrefe,Russell E, AU - Staley,Christopher A, AU - Schenker,Mara L, AU - Meals,Clifton, Y1 - 2019/07/09/ PY - 2018/06/29/received PY - 2019/03/25/revised PY - 2019/05/02/accepted PY - 2019/7/14/pubmed PY - 2019/7/14/medline PY - 2019/7/14/entrez KW - Complications KW - distal radius KW - length of stay KW - malnutrition KW - readmission SP - 742 EP - 750 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 44 IS - 9 N2 - PURPOSE: Malnutrition is known to negatively affect outcomes after arthroplasty, hip fracture, and spine surgery. Although distal radius fracture surgery may be considered in a similar patient cohort, the effect of malnutrition in this scenario is unknown. We hypothesized that admission serum albumin level, as a marker for malnutrition, would correlate with the rate of postoperative complications following surgery for distal radius fracture. METHODS: We performed a retrospective cohort study of the American College of Surgeons National Surgery Quality Improvement database. Patients undergoing open reduction and internal fixation of a distal radius fracture were identified using Current Procedural Terminology codes. We excluded patients who were septic at presentation, were multiply injured, or had open fractures. We collected patient demographics, length of stay, 30-day complications, reoperation, and readmission rates. We performed multivariable linear regression analysis controlling for age, sex, body mass index, operative time, discharge destination, and modified Frailty Index score. RESULTS: We identified 1,989 patients (mean age, 56 years; range, 18-90 years) with available albumin levels, and 14.7% had hypoalbuminemia (albumin, < 3.5 g/dL). Multivariable regression revealed that malnourished patients had higher rates of postoperative complications (6.5% vs 1.3%; odds ratio [OR] 4.88; 95% confidence interval [95% CI], 2.47-9.66). Specifically, these patients had increased rates of Clavien-Dindo IV (life-threatening) complications (2.4% vs 0%), readmission (7.2% vs 2%; OR, 3.37; 95% CI, 1.88-6.03), and mortality (1.7% vs 0.1%; OR, 9.23; 95% CI, 1.55-54.87). Malnourished patients had significantly longer length of stay (3.55 vs 0.73 days). Albumin concentration was inversely associated with risk of death (OR, 0.12; 95% CI, 0.03-0.52). CONCLUSIONS: Malnutrition, indicated by albumin less than 3.5 g/dL, is a powerful predictor of uncommon, but important, postoperative complications, including mortality, following surgery for distal radius fracture. Evaluation of preoperative albumin level may, therefore, help surgeons provide individualized counseling and more accurately stratify the risk of patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/31300228/The_Effect_of_Malnutrition_on_Postoperative_Complications_Following_Surgery_for_Distal_Radius_Fractures_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0363-5023(18)30894-3 DB - PRIME DP - Unbound Medicine ER -
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