Lavernia C J, Sierra R J, Baerga L
University of Miami, School of Medicine, Florida, USA.
J Am Coll Nutr. 1999 Jun;18(3):274-8. doi: 10.1080/07315724.1999.10718863.
Advances in surgical techniques and management of arthroplasty patients have contributed to a significant reduction in surgical complication rates. Preoperative nutritional status has a significant impact on surgical outcome. Studies have reported improved outcomes in burn and hip fracture patients receiving nutritional supplementation during their recoveries. Our objective was to assess the effects of preoperative nutritional status on the incidence of complications, resource consumption, and length of stay of patients undergoing hip and knee replacement surgery.
One hundred and nineteen patients were evaluated. Standard preoperative 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 complications during hospitalization. Non-parametric Kruskall Wallis and chi-square statistical analyses were performed. A p value <.05 was considered significant.
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) or total hip arthroplasty (THA). Mean albumin and total lymphocyte count (TLC) were 38.5 g/L +/-4.78 SD and 1884 cells/microL +/-762 SD, respectively. Patients with albumin levels less than 34 g/L had 32.7% higher charges ($50,108+/-8203 SE vs. $33,720+/-1128 SE, p<.006), higher medical severity of illness (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/microL had higher charges ($32,544+/-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 vs. 198.6 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 TLC higher than 1200 cells/microL. These findings were still significant when adjusted for medical severity of illness and age.
Our data demonstrate that preoperative nutritional status is an excellent predictor of short term outcome. Serum albumin and TLC correlate 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.
手术技术的进步以及关节置换患者的管理措施已使手术并发症发生率显著降低。术前营养状况对手术结果有重大影响。研究报告称，烧伤和髋部骨折患者在恢复期间接受营养补充后，治疗效果有所改善。我们的目的是评估术前营养状况对接受髋膝关节置换手术患者并发症发生率、资源消耗及住院时间的影响。
对119例患者进行了评估。对所有患者进行了标准的术前实验室检查。使用查尔森合并症指数对所有患者的疾病严重程度进行了评估。记录了麻醉和手术时间。利用住院费用作为资源消耗的衡量指标、住院时间（LOS）、住院期间的会诊情况以及住院期间并发症的发生情况和数量来评估短期结果。进行了非参数Kruskal Wallis检验和卡方统计分析。p值<.05被认为具有统计学意义。
平均年龄为64.6岁±15.62岁。52.9%患有骨关节炎（OA），4.2%患有类风湿关节炎（RA），5.9%患有骨坏死（ON），9.2%发生了髋部骨折，28%的全膝关节置换术（TKA）或全髋关节置换术（THA）失败。平均白蛋白和总淋巴细胞计数（TLC）分别为38.5 g/L±4.78标准差和1884个细胞/微升±762标准差。白蛋白水平低于34 g/L的患者费用高出32.7%（50,108美元±8203标准误 vs. 33,720美元±1128标准误，p<.006），疾病严重程度更高（p =.03），住院时间更长（8.6天±1.7标准误 vs. 5.2天±.356标准误，p<.001）。与TLC高于1200个细胞/微升的患者相比，TLC低于1200个细胞/微升的患者费用更高（32,544美元±1050标准误 vs. 42,098美元±3122标准误，p =.004），住院时间更长（5.7天±.531天 vs. 5.4天±.368天，p =.004），麻醉时间更长（242.85分钟±17.55标准误 vs. 198.6分钟±6.06标准误，p =.02），手术时间更长（177.14分钟±17.57标准误 vs. 120.21分钟±6.22标准误，p =.002）。在对疾病严重程度和年龄进行调整后，这些结果仍然具有统计学意义。
我们的数据表明，术前营养状况是短期结果的良好预测指标。血清白蛋白和TLC与接受关节置换手术患者的资源消耗、住院时间和手术时间相关。术前通过营养补充可能会改善这些参数。
