Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Hip Int. 2020 Sep;30(5):635-640. doi: 10.1177/1120700019862977. Epub 2019 Jul 15.
This study sought to determine the effect that malnutrition, defined as hypoalbuminemia, has on hip fracture patients treated with total hip arthroplasty (THA). Specifically, we evaluated: (1) demographics and perioperative data; (2) postoperative complications; and (3) re-operation rates.
The National Surgical Quality Improvement Program database was utilised to identify hip fracture patients who underwent THA from 2008 to 2015. Propensity scores were calculated for the likelihood of having a preoperative albumin measurement. Hip fracture patients who underwent THA and had preoperative hypoalbuminemia (<3.5 g/dL) ( = 569) were compared to those who had normal albumin levels (⩾3.5 g/dL) ( = 1098) in terms of demographics and perioperative data. Regression models were adjusted for age, sex, modified Charlson/Deyo scores, and propensity scores to evaluate complication and re-operation rates.
Compared to controls, hypoalbuminemia patients were older (p = 0.006), more likely male ( = 0.024), had higher Charlson/Deyo scores ( = 0.0001), more likely smokers ( < 0.0001), more likely functionally dependent ( < 0.0001), had ASA scores ⩾3 ( < 0.0001) and had longer LOS ( < 0.0001). Compared to controls, hypoalbuminemia patients had 80% higher risk for any complication (OR = 1.80; 95% CI, 1.43-2.26), 113% higher risk for major complications (OR = 2.13; 95% CI, 1.31-3.48), and 79% higher risk for minor complications (OR = 1.79; 95% CI, 1.42-2.26), and 97% increased risk for re-operation (OR = 1.97; 95% CI, 1.20-3.23).
The findings in the present study indicate the need to develop better pre- and postoperative medical and nutritional care for malnourished hip fracture patients who undergo THA in order to potentially mitigate their increased risk.
本研究旨在确定营养不良（定义为低白蛋白血症）对接受全髋关节置换术（THA）治疗的髋部骨折患者的影响。具体而言，我们评估了：（1）人口统计学和围手术期数据；（2）术后并发症；（3）再次手术率。
利用国家手术质量改进计划数据库，确定 2008 年至 2015 年间接受 THA 的髋部骨折患者。计算了术前白蛋白检测的可能性的倾向评分。与术前白蛋白水平正常（⩾3.5 g/dL）（n=1098）的患者相比，术前存在低白蛋白血症（<3.5 g/dL）（n=569）的髋部骨折患者在人口统计学和围手术期数据方面进行了比较。使用回归模型调整年龄、性别、改良 Charlson/Deyo 评分和倾向评分，以评估并发症和再次手术率。
与对照组相比，低白蛋白血症患者年龄更大（p=0.006），男性比例更高（p=0.024），Charlson/Deyo 评分更高（p=0.0001），吸烟比例更高（p<0.0001），功能依赖性更高（p<0.0001），ASA 评分⩾3（p<0.0001）和 LOS 更长（p<0.0001）。与对照组相比，低白蛋白血症患者发生任何并发症的风险增加 80%（OR=1.80；95%CI，1.43-2.26），发生重大并发症的风险增加 113%（OR=2.13；95%CI，1.31-3.48），发生轻微并发症的风险增加 79%（OR=1.79；95%CI，1.42-2.26），再次手术的风险增加 97%（OR=1.97；95%CI，1.20-3.23）。
本研究的结果表明，需要为接受 THA 的营养不良髋部骨折患者制定更好的术前和术后医疗和营养护理计划，以降低其风险。
