Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
Arch Orthop Trauma Surg. 2023 Dec;143(12):7205-7212. doi: 10.1007/s00402-023-04987-8. Epub 2023 Jul 13.
Malnutrition is associated with poorer outcomes after revision total joint arthroplasty (rTJA), though no universal metric for assessing malnutrition in rTJA patients has been reported. This study sought to determine if malnutrition as defined by the Geriatric Nutritional Risk Index (GNRI) can independently predict short-term complication rates and re-revision risk in patients undergoing rTJA.
All patients ≥ 65 years old undergoing rTJA from 2011 to 2021 at a single orthopaedic specialty hospital were identified. Preoperative albumin, height, and weight were used to calculate GNRI. Based on the calculated GNRI value, patients were stratified into three groups: normal nutrition (GNRI > 98), moderate malnutrition (GNRI 92-98), and severe malnutrition (GNRI < 92). Chi-squared and independent samples t-tests were used to compare groups.
A total of 531 rTJA patients were included. Patients with normal nutrition were younger (p < 0.001), had higher BMI (p < 0.001). After adjusting for baseline characteristics, patients with severe and moderate malnutrition had longer length of stay (p < 0.001), were less likely to be discharged home (p = 0.049), and had higher 90-day major complication (p = 0.02) and readmission (p = 0.005) rates than those with normal nutrition. 90-day revision rates were similar. In Kaplan-Meier analyses, patients with severe and moderate malnutrition had worse survivorship free of all-cause re-revision at 1-year (p = 0.001) and 2-year (p = 0.002) follow-up compared to those with normal nutrition.
Moderate and severe malnutrition, as defined by GNRI, independently predicted higher complication and revision rates in rTJA patients. This suggests that the GNRI may serve as an effective screening tool for nutritional status in patients undergoing rTJA.
营养不良与翻修全关节置换术后（rTJA）的不良结果相关，尽管尚未报道用于评估 rTJA 患者营养不良的通用指标。本研究旨在确定根据老年营养风险指数（GNRI）定义的营养不良是否可以独立预测接受 rTJA 的患者的短期并发症发生率和再次翻修风险。
在一家骨科专科医院，从 2011 年至 2021 年期间，确定所有≥65 岁接受 rTJA 的患者。使用术前白蛋白、身高和体重计算 GNRI。根据计算出的 GNRI 值，患者分为三组：正常营养（GNRI＞98）、中度营养不良（GNRI 92-98）和重度营养不良（GNRI＜92）。使用卡方检验和独立样本 t 检验比较组间差异。
共纳入 531 例 rTJA 患者。正常营养组患者年龄较小（p＜0.001），BMI 较高（p＜0.001）。调整基线特征后，重度和中度营养不良患者的住院时间较长（p＜0.001），出院回家的可能性较小（p=0.049），90 天主要并发症（p=0.02）和再入院（p=0.005）发生率较高，而正常营养组则较低。90 天翻修率相似。在 Kaplan-Meier 分析中，重度和中度营养不良患者在 1 年（p=0.001）和 2 年（p=0.002）随访时无全因再次翻修的生存率较差。
根据 GNRI 定义的中度和重度营养不良独立预测了 rTJA 患者更高的并发症和翻修率。这表明 GNRI 可能作为 rTJA 患者营养状况的有效筛查工具。
