Roche Martin, Law Tsun Yee, Kurowicki Jennifer, Sodhi Nipun, Rosas Samuel, Elson Leah, Summers Spencer, Sabeh Karim, Mont Michael A
Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida.
Department of Orthopaedic Surgery, St. Joesph's Regional Medical Center, Paterson, New Jersey.
J Knee Surg. 2018 Nov;31(10):946-951. doi: 10.1055/s-0038-1672122. Epub 2018 Oct 3.
Nutritional status has become increasingly important in optimizing surgical outcomes and preventing postoperative infection and wound complications. However, currently, there is a paucity in the orthopaedics literature investigating the relationship between nutritional status and wound complications following total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine the prevalence of (1) postoperative infections, (2) wound complications, (3) concomitant infection with wound (CoIW) complication, and (4) infection followed by wound complication by using (1) albumin, (2) prealbumin, and (3) transferrin levels as indicators of nutritional status. These four different outcome measures were chosen as they are encountered commonly in daily clinical practice. A retrospective review of a national private payer database for patients who underwent TKA with postoperative infections and wound complications stratified by preoperative serum albumin (normal: 3.5-5 g/dL), prealbumin (normal: 16-35 mg/dL), and transferrin levels (normal: 200-360 mg/dL) between 2007 and 2015 was conducted. Patients were identified by Current Procedural Terminology (CPT), International Classification of Disease, ninth revision (ICD-9) codes, and Logical Observation Identifiers Names and Codes (LOINC). Linear regression was performed to evaluate changes over times. Yearly rates of infection, as well as a correlation and odds ratio analysis of nutritional laboratory values to postoperative complications, were also performed. Our query returned a total of 161,625 TKAs, of which 11,047 (7%) had postoperative wound complications, 18,403 (11%) had infections, 6,296 (34%) had CoIW, and 4,877 (4%) patients with infection developed wound complications. Albumin was the most commonly ordered laboratory test when assessing complications (96%). Wound complications, infections, CoIW, and infection with wound complications after were higher in those below the normal range: albumin <3.5 g/dL (9, 14, 6, and 5%), prealbumin <15 mg/dL (20, 23, 13, and 12%), and transferrin <200 mg/dL (12, 17, 6, and 6%). Preoperative albumin, prealbumin, and transferrin values falling below the normal range represented an increased risk for postoperative complications. Those patients who were in the normal range, however, did not have an increased risk. Therefore, our results suggest that preoperative nutritional optimization can play an important role in reducing the risk for postoperative complications.
营养状况在优化手术效果、预防术后感染及伤口并发症方面变得愈发重要。然而，目前骨科文献中关于全膝关节置换术（TKA）后营养状况与伤口并发症之间关系的研究较少。因此，本研究的目的是通过将（1）白蛋白、（2）前白蛋白和（3）转铁蛋白水平作为营养状况指标，来确定（1）术后感染、（2）伤口并发症、（3）伤口合并感染（CoIW）并发症以及（4）感染后继发伤口并发症的发生率。选择这四种不同的结局指标是因为它们在日常临床实践中较为常见。对一个全国性私人医保数据库进行回顾性研究，该数据库收录了2007年至2015年间接受TKA且术后发生感染和伤口并发症的患者，根据术前血清白蛋白（正常范围：3.5 - 5 g/dL）、前白蛋白（正常范围：16 - 35 mg/dL）和转铁蛋白水平（正常范围：200 - 360 mg/dL）进行分层。通过当前手术操作术语（CPT）、国际疾病分类第九版（ICD - 9）编码以及逻辑观察标识符名称和编码（LOINC）来识别患者。进行线性回归以评估随时间的变化。还进行了感染的年发生率以及营养实验室值与术后并发症的相关性和比值比分析。我们的查询共返回161,625例TKA病例，其中11,047例（7%）有术后伤口并发症，18,403例（11%）有感染，6,296例（34%）有CoIW，4,877例（4%）感染患者出现伤口并发症。评估并发症时，白蛋白是最常进行的实验室检查（96%）。正常范围以下的患者发生伤口并发症、感染、CoIW以及感染后继发伤口并发症的比例更高：白蛋白<3.5 g/dL（9%、14%、6%和5%），前白蛋白<15 mg/dL（20%、23%、13%和12%），转铁蛋白<200 mg/dL（12%、17%、6%和6%）。术前白蛋白、前白蛋白和转铁蛋白值低于正常范围表明术后并发症风险增加。然而，处于正常范围的患者并未增加风险。因此，我们的结果表明术前营养优化在降低术后并发症风险方面可发挥重要作用。
