Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA.
J Orthop Trauma. 2019 Jun;33(6):284-291. doi: 10.1097/BOT.0000000000001448.
Malnutrition, as indicated by hypoalbuminemia, is known to have detrimental effects on outcomes after arthroplasty, geriatric hip fractures, and multiple general surgeries. Hypoalbuminemia has been examined in the critically ill but has largely been ignored in the orthopaedic trauma literature. We hypothesized that admission albumin levels would correlate with postoperative course in the nongeriatric lower extremity trauma patient.
Patients with lower extremity (including pelvis and acetabulum) fracture who underwent operative intervention were collected from the ACS-NSQIP database. Patients younger than 65 years were included. Patient demographic data, complications, length of stay, reoperation rate, and readmission rate were collected, and patient modified frailty index scores were calculated. Poisson regression with robust error variance was then conducted, controlling for potential confounders.
Five thousand six hundred seventy-three patients with albumin available were identified, and 29.6% had hypoalbuminemia. Hypoalbuminemic patients had higher rates of postoperative complications [9.3% vs. 2.6%; relative risk (RR) 1.63] including increased rates of: mortality (3.2% vs. 0.4%; RR 4.86, 95% confidence interval 2.66-8.87), sepsis (1.5% vs. 0.5%, RR 2.35), and reintubation (2.3% vs. 0.4%; RR 3.84). Reoperation (5.5% vs. 2.6%, RR 1.74) and readmission (11.4% vs. 4.1%; RR 2.53) rates were also higher in patients with low albumin.
Hypoalbuminemia is a powerful predictor of acute postoperative course and mortality after surgical fixation in nongeriatric, lower extremity orthopaedic trauma patients. Admission albumin should be a routine part of the orthopaedic trauma workup. Further study into the utility of supplementation is warranted, as this may represent a modifiable risk factor.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
低蛋白血症表明营养不良，已知对关节置换术后、老年髋部骨折和多种普通外科手术的结果有不利影响。危重病患者的低蛋白血症已经得到了检查，但在骨科创伤文献中基本上被忽视了。我们假设入院时的白蛋白水平与非老年下肢创伤患者的术后过程相关。
从 ACS-NSQIP 数据库中收集接受手术干预的下肢（包括骨盆和髋臼）骨折患者。纳入年龄小于 65 岁的患者。收集患者的人口统计学数据、并发症、住院时间、再次手术率和再入院率，并计算患者改良虚弱指数评分。然后进行带有稳健误差方差的泊松回归，控制潜在混杂因素。
确定了 5673 名白蛋白可用的患者，其中 29.6%存在低蛋白血症。低蛋白血症患者术后并发症发生率更高[9.3%比 2.6%；相对风险 (RR) 1.63]，包括更高的死亡率（3.2%比 0.4%；RR 4.86，95%置信区间 2.66-8.87）、败血症（1.5%比 0.5%，RR 2.35）和重新插管（2.3%比 0.4%；RR 3.84）。低白蛋白血症患者的再次手术（5.5%比 2.6%，RR 1.74）和再入院（11.4%比 4.1%，RR 2.53）率也更高。
在非老年下肢骨科创伤患者中，低蛋白血症是手术固定后急性术后过程和死亡率的有力预测因素。入院时的白蛋白应成为骨科创伤评估的常规部分。进一步研究补充的效用是合理的，因为这可能是一个可改变的风险因素。
预后 III 级。有关证据水平的完整描述，请参阅作者说明。
