Nutritional parameters and short term outcome in arthroplasty

Objective: Advances in surgical techniques and management of arthroplasty p atients have contributed to a significant reduction in surgical complicatio n rates. Preoperative nutritional status has a significant impact on surgic al outcome. Studies have reported improved outcomes in burn and hip fractur e patients receiving nutritional supplementation during their recoveries. O ur objective was to assess the effects of preoperative nutritional status o n the incidence of complications, resource consumption, and length of stay of patients undergoing hip and knee replacement surgery. Methods: One hundred and nineteen patients were evaluated. Standard preoper ative laboratory tests were; performed on all patients. Medical severity of illness was assessed on all patients using the Charlson Comorbidity Index. Anesthesia and surgical time was recorded. Short term outcome was assessed utilizing hospital charges as a measure of resource consumption, length of stay (LOS), in-hospital consults and the presence and number of complicati ons during hospitalization. Non-parametric Kruskall Wallis and chi-square s tatistical analyses were performed. A p value <.05 was considered significa nt. Results: Mean age was 64.6 years +/- 15.62. 52.9% had osteoarthritis (OA), 4.2% had rheumatoid arthritis (RA), 5.9% had osteonecrosis (ON), 9.2% had a hip fracture and 28% had a failed total knee arthroplasty (TKA) of total h ip arthroplasty (THA). Mean albumin and total lymphocyte count (TLC) were 3 8.5 g/L +/- 4.78 SD and 1884 cells/mu L +/- 762 SD, respectively. Patients with albumin levels less than 34 gn had 32.7% higher charges ($50,108 +/- 8 203 SE vs. $33,720 +/- 1128 SE, p < .006), higher medical severity of illne ss (p = .03) and longer LOS (8.6 +/- 1.7 SE vs. 5.2 +/- .356 SE days, p < . 001). Patients with TLC less than 1200 cells/mu L had higher charges ($32,5 44 +/- 1050 SE vs. $42,098 +/- 3122 SE, p = .004), longer LOS (5.7 +/- .531 vs. 5.4 days +/- .368, p = .004) and anesthesia (242.85 +/- 17.55 SE ps 19 8.6 min. +/- 6.06 SE, p = .02) and surgical times (177.14 min. +/- 17.57 SE vs. 120.21 min. +/- 6.22 SE, p = .002) when compared with patients with TL C higher than 1200 cells/mu L. These findings were still significant when a djusted for medical severity of illness and age. Conclusions: Our data demonstrate that preoperative nutritional status is a n excellent predictor of short term outcome. Serum albumin and TLC correlat e with resource consumption, length of stay and operative time in patients undergoing joint replacement surgery. These parameters may be improved with nutritional supplementation prior to surgery.