Kamath Atul F, Nelson Charles L, Elkassabany Nabil, Guo Zhenggang, Liu Jiabin
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.
J Knee Surg. 2017 Mar;30(3):269-275. doi: 10.1055/s-0036-1584575. Epub 2016 Jun 30.
Low serum albumin has been shown in the primary joint arthroplasty setting to increase the rate of perioperative complications. Our present work examined a large national inpatient administrative dataset to study the relationship between serum albumin level and key outcome measures after revision total knee arthroplasty (RTKA). Our hypothesis was that lower serum albumin would be an independent risk factor for poor outcomes after RTKA. We analyzed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2014, specifically evaluating patients undergoing RTKA. Patients were grouped as having hypoalbuminemia (serum albumin < 3.5 mg/dL) or normal albumin (serum albumin ≥ 3.5). We analyzed data on 22 complications as reported in the NSQIP database and developed composite complication variables (any infections, cardiac/pulmonary complications, and any major complications). For each complication, multivariable logistic regression analysis was used to evaluate its association. The cohort included 4,551 patients undergoing RTKA. Patients in the low serum albumin group were statistically more likely to develop deep surgical site infection, organ space surgical site infection, pneumonia, urinary traction infection, and sepsis. The hypoalbuminemic group was more likely to require unplanned intubation, blood transfusion intraoperatively or postoperatively, remain on a ventilator > 48 hours, and develop acute renal failure. There was also a higher risk of mortality and coma. Across the three composite complication variables, any complication (with or without transfusion), any major complication, and any infection (systemic, wound) were more prevalent among the patients with low serum albumin. This study confirms the relationship between suboptimal nutritional status and complications following RTKA. Hypoalbuminemia may be used as a potential preoperative predictor of outcomes. Understanding the effects of malnutrition on perioperative complications informs the choice of appropriate candidates for surgical intervention, timing of surgery, resource allocation, and risk counseling preoperatively.
在初次关节置换手术中，低血清白蛋白已被证明会增加围手术期并发症的发生率。我们目前的研究分析了一个大型的全国住院患者管理数据集，以研究血清白蛋白水平与全膝关节置换翻修术（RTKA）后关键结局指标之间的关系。我们的假设是，较低的血清白蛋白将是RTKA术后不良结局的独立危险因素。我们分析了美国外科医师学会国家外科质量改进计划（NSQIP）2006年至2014年的数据库，特别评估了接受RTKA的患者。患者被分为低白蛋白血症组（血清白蛋白<3.5mg/dL）或正常白蛋白组（血清白蛋白≥3.5）。我们分析了NSQIP数据库中报告的22种并发症的数据，并制定了复合并发症变量（任何感染、心脏/肺部并发症和任何主要并发症）。对于每种并发症，使用多变量逻辑回归分析来评估其相关性。该队列包括4551例接受RTKA的患者。低血清白蛋白组的患者在统计学上更有可能发生深部手术部位感染、器官间隙手术部位感染、肺炎、泌尿道感染和败血症。低白蛋白血症组更有可能需要进行非计划插管、术中或术后输血、使用呼吸机>48小时以及发生急性肾衰竭。死亡和昏迷的风险也更高。在这三个复合并发症变量中，任何并发症（无论是否输血）、任何主要并发症以及任何感染（全身性、伤口感染）在低血清白蛋白患者中更为普遍。这项研究证实了RTKA术后营养状况不佳与并发症之间的关系。低白蛋白血症可作为潜在的术前结局预测指标。了解营养不良对围手术期并发症的影响有助于指导手术干预合适候选人的选择、手术时机、资源分配以及术前风险咨询。
