Liu Steven H, Lung Brandon, Burgan Jane, Loyst Rachel A, Liu Rebecca, Bramian Allen, Nicholson James J, Stitzlein Russell N
University of Southern California, Los Angeles, USA.
University of California, Irvine Medical Center, Orange, USA.
Eur J Orthop Surg Traumatol. 2025 May 23;35(1):213. doi: 10.1007/s00590-025-04317-1.
This study investigates the association between the geriatric nutritional risk index (GNRI), a readily available index measuring the risk of malnutrition, and 30-day postoperative complications following revision total knee arthroplasty (rTKA).
The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients ≥ 65 who underwent rTKA between 2015 and 2021. The study population was divided into three groups based on preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92). Multivariate logistic regression analysis was conducted to investigate the association between preoperative GNRI and postoperative complications.
Compared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, blood transfusions, surgical site infection (SSI), non-home discharge, readmission, length of stay (LOS) > 2 days, and mortality. Severe malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, septic shock, pneumonia, unplanned reintubation, cardiac arrest or myocardial infarction, stroke, blood transfusions, still on ventilator > 48 h, SSI, wound dehiscence, acute renal failure, non-home discharge, readmission, unplanned reoperation, LOS > 2 days, and mortality. Severe malnutrition was independently significantly associated with a greater number of complications and had a stronger association with complications compared to moderate malnutrition.
Malnutrition identified by GNRI has strong predictive value for short-term postoperative complications following rTKA in geriatric patients and may have utility as an adjunctive risk stratification tool for geriatric patients undergoing rTKA.
本研究调查了老年营养风险指数（GNRI）与翻修全膝关节置换术（rTKA）后30天术后并发症之间的关联，GNRI是一种易于获得的衡量营养不良风险的指标。
查询美国外科医师学会国家外科质量改进计划数据库，获取2015年至2021年间接受rTKA的所有≥65岁患者。根据术前GNRI将研究人群分为三组：正常/参考组（GNRI>98）、中度营养不良组（92≤GNRI≤98）和重度营养不良组（GNRI<92）。进行多因素逻辑回归分析以研究术前GNRI与术后并发症之间的关联。
与正常营养相比，中度营养不良与发生任何并发症、输血、手术部位感染（SSI）、非回家出院、再入院、住院时间（LOS）>2天及死亡的可能性显著增加独立相关。重度营养不良与发生任何并发症、感染性休克、肺炎、计划外再次插管、心脏骤停或心肌梗死、中风、输血、机械通气>48小时、SSI、伤口裂开、急性肾衰竭、非回家出院、再入院、计划外再次手术、LOS>2天及死亡的可能性显著增加独立相关。重度营养不良与更多并发症独立显著相关，且与并发症的关联比中度营养不良更强。
GNRI识别出的营养不良对老年患者rTKA术后短期并发症具有很强的预测价值，可能作为老年rTKA患者辅助风险分层工具。
