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Role of Hypoalbuminemia as an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures.
Foot Ankle Int. 2020 Mar; 41(3):303-312.FA

Abstract

BACKGROUND

Malnutrition is known to be negatively associated with outcomes after multiple orthopedic procedures. We hypothesized that admission albumin levels, as a marker for malnutrition, would correlate with postoperative outcomes. The purpose of this study was to investigate this relationship following surgery for ankle fracture.

METHODS

This is a retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients undergoing operative fixation of an ankle fracture were identified. A total of 6138 patients with albumin available for analysis were identified. Baseline patient information, preoperative serum albumin levels, 30-day postoperative complications, readmission, reoperation, and length of stay data were then collected. Poisson regression with robust error variance was performed to assess the effect of preoperative serum albumin level on postoperative outcomes.

RESULTS

The mean albumin level was 3.86 g/dL and 20.3% (1246/6138) of patients with available albumin levels were hypoalbuminemic. Multivariate analysis revealed that an albumin level <3.5 g/dL was an independent risk factor for complications (relative risk [RR], 1.42; 95% confidence interval [CI], 1.13-1.78; P = .002) and readmission (RR, 1.54; 95% CI, 1.13-2.08; P = .006). Additionally, when analyzed as a continuous variable, albumin level was negatively correlated with risk of mortality (RR, 0.37; 95% CI, 0.19-0.72; P = .003). Patients with hypoalbuminemia also had significantly longer lengths of stay (4.5 vs 2.1 days; P < .001).

CONCLUSION

While complication rates after fixation of ankle fractures remain low, hypoalbuminemia was a predictor of postoperative course. Malnutrition, therefore, may help inform the decision between surgical and conservative management of patients with ankle fractures potentially amenable to nonoperative management. Additionally, hypoalbuminemia should trigger heightened awareness and prophylactic therapy where appropriate.

LEVEL OF EVIDENCE

Level III, comparative study.

Authors+Show Affiliations

Department of Orthopedic Surgery, School of Medicine, Emory University, Atlanta, GA, USA.Department of Orthopedic Surgery, School of Medicine, Emory University, Atlanta, GA, USA.Department of Orthopedic Surgery, School of Medicine, Emory University, Atlanta, GA, USA.Department of Orthopedic Surgery, School of Medicine, Emory University, Atlanta, GA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31868015

Citation

Wilson, Jacob M., et al. "Role of Hypoalbuminemia as an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures." Foot & Ankle International, vol. 41, no. 3, 2020, pp. 303-312.
Wilson JM, Kukowski NR, Staley CA, et al. Role of Hypoalbuminemia as an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures. Foot Ankle Int. 2020;41(3):303-312.
Wilson, J. M., Kukowski, N. R., Staley, C. A., & Bariteau, J. T. (2020). Role of Hypoalbuminemia as an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures. Foot & Ankle International, 41(3), 303-312. https://doi.org/10.1177/1071100719895222
Wilson JM, et al. Role of Hypoalbuminemia as an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures. Foot Ankle Int. 2020;41(3):303-312. PubMed PMID: 31868015.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of Hypoalbuminemia as an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures. AU - Wilson,Jacob M, AU - Kukowski,Nathan R, AU - Staley,Christopher A, AU - Bariteau,Jason T, Y1 - 2019/12/22/ PY - 2019/12/24/pubmed PY - 2019/12/24/medline PY - 2019/12/24/entrez KW - albumin KW - ankle fracture KW - complications KW - hypoalbuminemia KW - malnutrition KW - outcomes SP - 303 EP - 312 JF - Foot & ankle international JO - Foot Ankle Int VL - 41 IS - 3 N2 - BACKGROUND: Malnutrition is known to be negatively associated with outcomes after multiple orthopedic procedures. We hypothesized that admission albumin levels, as a marker for malnutrition, would correlate with postoperative outcomes. The purpose of this study was to investigate this relationship following surgery for ankle fracture. METHODS: This is a retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients undergoing operative fixation of an ankle fracture were identified. A total of 6138 patients with albumin available for analysis were identified. Baseline patient information, preoperative serum albumin levels, 30-day postoperative complications, readmission, reoperation, and length of stay data were then collected. Poisson regression with robust error variance was performed to assess the effect of preoperative serum albumin level on postoperative outcomes. RESULTS: The mean albumin level was 3.86 g/dL and 20.3% (1246/6138) of patients with available albumin levels were hypoalbuminemic. Multivariate analysis revealed that an albumin level <3.5 g/dL was an independent risk factor for complications (relative risk [RR], 1.42; 95% confidence interval [CI], 1.13-1.78; P = .002) and readmission (RR, 1.54; 95% CI, 1.13-2.08; P = .006). Additionally, when analyzed as a continuous variable, albumin level was negatively correlated with risk of mortality (RR, 0.37; 95% CI, 0.19-0.72; P = .003). Patients with hypoalbuminemia also had significantly longer lengths of stay (4.5 vs 2.1 days; P < .001). CONCLUSION: While complication rates after fixation of ankle fractures remain low, hypoalbuminemia was a predictor of postoperative course. Malnutrition, therefore, may help inform the decision between surgical and conservative management of patients with ankle fractures potentially amenable to nonoperative management. Additionally, hypoalbuminemia should trigger heightened awareness and prophylactic therapy where appropriate. LEVEL OF EVIDENCE: Level III, comparative study. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/31868015/Role_of_Hypoalbuminemia_as_an_Independent_Predictor_of_30_Day_Postoperative_Complications_Following_Surgical_Fixation_of_Ankle_Fractures_ L2 - https://journals.sagepub.com/doi/10.1177/1071100719895222?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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