Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center/North Shore University Hospital, New Hyde Park, New York.
J Arthroplasty. 2023 Jul;38(7):1326-1329. doi: 10.1016/j.arth.2023.02.077. Epub 2023 Mar 5.
The association between malnutrition and complications following primary total joint arthroplasty is well-delineated; however, nutritional status has yet to be explored specifically in revision total hip arthroplasty (THA). Therefore, our objective was to examine if a patient's nutritional status based on body mass index, diabetic status, and serum albumin predicted complications following a revision THA.
A retrospective national database review identified 12,249 patients who underwent revision THA from 2006 to 2019. Patients were stratified based on body mass index (<18.5 = underweight, 18.5-29.9 = healthy/overweight, ≥30 = obese), diagnosis of diabetes (no diabetes, insulin-dependent diabetes mellitus (IDDM), non-insulin-dependent diabetes mellitus), and preoperative serum albumin (<3.5 = malnourished, ≥3.5 = non-malnourished). Multivariate analyses were performed using chi-square tests and multiple logistic regressions.
In all groups including underweight (1.8%), healthy/overweight (53.7%), and obese (44.5%), those without diabetes were less likely to be malnourished (P < .001), while those with IDDM had a higher rate of malnutrition (P < .001). Underweight patients were significantly more malnourished compared to healthy/overweight or obese patients (P < .05). Malnourished patients had an increased risk of wound dehiscence/surgical site infections (P < .001), urinary tract infection (P < .001), requiring a blood transfusion (P < .001), sepsis (P < .001), and septic shock (P < .001). Malnourished patients also have worse postoperative pulmonary and renal function.
Patients who are underweight or have IDDM are more likely to be malnourished. The risk of complications within 30 days of surgery following revision THA significantly increases with malnutrition. This study shows the utility of screening underweight and IDDM patients for malnutrition prior to revision THA to minimize complications.
营养不良与初次全关节置换术后并发症之间的关系已得到充分阐明；然而，在翻修全髋关节置换术（THA）中，尚未专门探讨营养状况。因此，我们的目的是研究患者的营养状况（基于体重指数、糖尿病状态和血清白蛋白）是否可预测翻修 THA 后的并发症。
对 2006 年至 2019 年间进行翻修 THA 的 12249 例患者进行回顾性国家数据库研究。根据体重指数（<18.5=消瘦，18.5-29.9=健康/超重，≥30=肥胖）、糖尿病诊断（无糖尿病、胰岛素依赖型糖尿病（IDDM）、非胰岛素依赖型糖尿病）和术前血清白蛋白（<3.5=营养不良，≥3.5=非营养不良）对患者进行分层。采用卡方检验和多因素逻辑回归进行多变量分析。
在包括消瘦（1.8%）、健康/超重（53.7%）和肥胖（44.5%）在内的所有组中，无糖尿病患者营养不良的可能性较低（P<.001），而 IDDM 患者的营养不良发生率较高（P<.001）。消瘦患者明显比健康/超重或肥胖患者更容易营养不良（P<.05）。营养不良患者发生伤口裂开/手术部位感染（P<.001）、尿路感染（P<.001）、需要输血（P<.001）、败血症（P<.001）和感染性休克（P<.001）的风险增加。营养不良患者术后肺部和肾功能也较差。
消瘦或 IDDM 的患者更容易发生营养不良。翻修 THA 后 30 天内手术并发症的风险随着营养不良的增加而显著增加。本研究表明，在翻修 THA 前对消瘦和 IDDM 患者进行营养不良筛查，可降低并发症的发生率。
