Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
J Arthroplasty. 2020 Dec;35(12):3505-3511. doi: 10.1016/j.arth.2020.06.073. Epub 2020 Jun 30.
Nutritional optimization before total joint arthroplasty (TJA) may improve patient outcomes and decrease costs. However, the utility of serologic laboratory markers, including albumin, transferrin, and total lymphocyte count (TLC), as primary indicators of nutrition is unclear. We analyzed the prevalence of abnormal nutritional values before TJA and identified factors associated with them.
We retrospectively reviewed 819 primary cases of TJA performed at 1 institution from January to December 2018. Patient demographic characteristics were assessed for associations with abnormal preoperative nutritional values (albumin <3.5 g/dL, transferrin <200 mg/dL, and TLC <1.5 cells/μL). Associations of comorbidities, American Society of Anesthesiologists Physical Status classification, and age-adjusted Charlson Comorbidity Index (CCI) with abnormal values were assessed with logistic regression.
Values were abnormal for albumin in 21 cases (2.6%), transferrin in 26 cases (5.6%), and TLC in 185 cases (25%). Thirteen cases (1.7%) had abnormal values for 2 markers. Age was associated with abnormal albumin and TLC, and race with abnormal transferrin. Congestive heart failure, chronic kidney disease, pancreatic insufficiency, gastroesophageal reflux disease, osteoporosis, dementia, and CCI were associated with abnormal albumin; Parkinson disease and American Society of Anesthesiologists Physical Status with abnormal transferrin; and dementia, body mass index, cancer history, and CCI with abnormal TLC.
We report low prevalence of and a low concordance rate among abnormal nutritional values before primary TJA. Our results suggest that routine testing of all healthy patients is not warranted before TJA.
全膝关节置换术（TJA）前的营养优化可能改善患者的预后并降低成本。然而，血清学实验室标志物（包括白蛋白、转铁蛋白和总淋巴细胞计数（TLC））作为营养的主要指标的效用尚不清楚。我们分析了 TJA 前异常营养值的发生率，并确定了与之相关的因素。
我们回顾性分析了 2018 年 1 月至 12 月在 1 家机构进行的 819 例原发性 TJA 病例。评估患者的人口统计学特征与术前异常营养值（白蛋白<3.5 g/dL、转铁蛋白<200 mg/dL 和 TLC<1.5 细胞/μL）之间的相关性。使用逻辑回归评估合并症、美国麻醉医师协会身体状况分类和年龄调整后的 Charlson 合并症指数（CCI）与异常值的相关性。
白蛋白值异常 21 例（2.6%），转铁蛋白值异常 26 例（5.6%），TLC 值异常 185 例（25%）。13 例（1.7%）有 2 种标志物异常。年龄与白蛋白和 TLC 异常相关，种族与转铁蛋白异常相关。充血性心力衰竭、慢性肾脏病、胰腺功能不全、胃食管反流病、骨质疏松症、痴呆和 CCI 与白蛋白异常相关；帕金森病和美国麻醉医师协会身体状况与转铁蛋白异常相关；痴呆、体重指数、癌症史和 CCI 与 TLC 异常相关。
我们报告了原发性 TJA 前异常营养值的发生率低且一致性率低。我们的结果表明，在 TJA 前对所有健康患者进行常规检测是没有必要的。
