Tischler Eric H, McDermott Jake R, Vummidi Shivasuryan, Mahmoud Samer A, Gross Jonathan M, Malik Aden N, Suneja Nishant
Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA.
Department of Orthopaedic Surgery, Northwell Health -Staten Island University Hospital, 375 Seguine Avenue, Staten Island, NY, 10309, USA.
Arch Orthop Trauma Surg. 2024 Dec 18;145(1):66. doi: 10.1007/s00402-024-05725-4.
Hypoalbuminemia, blanketly defined as Albumin < 3.5 g/dL, is often utilized as a threshold associated with postoperative complications and mortality among orthopedic and non-orthopedic surgical procedures. Albumin level is influenced by a myriad of factors including liver function, malnutrition, and inflammation. This study evaluates the role preoperative albumin as an independent risk factor for mortality and increased length of stay (LOS) among distal femur fracture (DFF) patients.
Between 2010 and 2019, the National Surgical Quality Improvement Program (NSQIP) identified isolated closed distal femur fractures preoperative albumin levels using International Classification of Diseases 9th and 10th revisions (ICD9/ICD10) codes [S72.4*; 821.2*]. Albumin was categorized as both continuous and categorical variables: marked hypoalbuminemia (< 2.5 g/dL), mild hypoalbuminemia (2.5-3.5 g/dL), normal albuminemia (3.5-4.5 g/dL) or hyperalbuminemia (> 4.5 g/dL). Primary outcomes included in-hospital mortality and LOS.
The incidence rate of hypoalbuminemia was 54.6% (419/767). Multivariable logistic regression analysis demonstrated that when compared to patients with baseline marked hypoalbuminemia, patients with mild hypoalbuminemia and normal serum albumin reported a respective 82% (OR 0.18, 95% CI [0.04, 0.71], p = 0.014) and 80% (OR: 0.20, 95% CI [0.05, 0.89], p = 0.034) decreased odds of in-hospital mortality. Similarly, a 53.7% (OR 0.46, 95% CI [0.23, 0.94], p = 0.033), 71.1% (OR 0.29, 95% CI [0.14, 0.60], p = 0.001), and 82.8% (OR 0.17, 95% [0.04, 0.75], p = 0.020) decreased odds of exceeding mean LOS was observed among mild hypoalbuminemic, normal, and hyperalbuminemic patients compared to patients with baseline marked hypoalbuminemia.
Preoperative hypoalbuminemia is an independent risk factor for increased LOS and mortality among DFFs, controlling for confounding factors. Prospective investigation of albumin risk stratification is warranted to differentiate contributable effects of chronic malnutrition and traumatic inflammatory albumin downregulation among geriatric trauma patients.
Prognostic Level III.
低白蛋白血症通常被定义为白蛋白<3.5g/dL，常用于骨科和非骨科手术中与术后并发症及死亡率相关的阈值。白蛋白水平受多种因素影响，包括肝功能、营养不良和炎症。本研究评估术前白蛋白作为股骨远端骨折（DFF）患者死亡率及住院时间延长（LOS）的独立危险因素的作用。
2010年至2019年期间，国家外科质量改进计划（NSQIP）使用国际疾病分类第9版和第10版（ICD9/ICD10）编码[S72.4*；821.2*]确定孤立性闭合性股骨远端骨折患者的术前白蛋白水平。白蛋白被分类为连续变量和分类变量：显著低白蛋白血症（<2.5g/dL）、轻度低白蛋白血症（2.5 - 3.5g/dL）、正常白蛋白血症（3.5 - 4.5g/dL）或高白蛋白血症（>4.5g/dL）。主要结局包括住院死亡率和住院时间。
低白蛋白血症的发生率为54.6%（419/767）。多变量逻辑回归分析表明，与基线显著低白蛋白血症患者相比，轻度低白蛋白血症患者和血清白蛋白正常的患者住院死亡率分别降低了82%（OR 0.18，95%CI[0.04，0.71]，p = 0.014）和80%（OR：0.20，95%CI[0.05，0.89]，p = 0.034）。同样，与基线显著低白蛋白血症患者相比，轻度低白蛋白血症、正常白蛋白血症和高白蛋白血症患者超过平均住院时间的几率分别降低了53.7%（OR 0.46，95%CI[0.23，0.94]，p = 0.033）、71.1%（OR 0.29，95%CI[0.14，0.60]，p = 0.001）和82.8%（OR 0.17，95%[0.04，0.75]，p = 0.020）。
术前低白蛋白血症是DFF患者住院时间延长和死亡率增加的独立危险因素，可控制混杂因素。有必要对白蛋白风险分层进行前瞻性研究，以区分老年创伤患者慢性营养不良和创伤性炎症导致白蛋白下调的可归因效应。
预后III级。
