Hypoalbuminemia associated perioperative mortality, reoperation, and readmission rates among total joint arthroplasty procedures: a systematic review and meta-analysis.

BACKGROUND

Albumin had consistently demonstrated an association with readmission, reoperation and mortality rates among total joint arthroplasty (TJA) patients. The currently literature demonstrates variable effect sizes of hypoalbuminemia and postoperative outcomes.

METHODS

PubMed/MEDLINE, Embase, Ovid, CENTRAL, the trial register, and Scopus were searched. Associations between preoperative albumin and postoperative readmission, reoperation, and mortality among TJA patients were determined. Zero-event rates were included with the Freeman-Tukey and study heterogeneity > 50% was accounted for with a random-effects model Subgroup analyses were conducted for total shoulder (TSA), knee (TKA), and hip arthroplasty (THA).

RESULTS

Twenty-one eligible studies with 605,942 patients were included. Hypoalbuminemia reported a 1.99, 2.20, and 3.93 -fold increased odds of readmission (OR 1.99, 95% CI 1.66-2.39; p < 0.001), reoperation (OR 2.20, 95% CI 1.73-2.81; p < 0.001) and mortality (OR 3.93, 95% CI 2.56-6.05; p < 0.001), with significant respective heterogeneity of I2 = 90%, 78% and 95%. On subgroup analysis, hypoalbuminemia respectively exhibited 1.30 (OR 1.30, 95% CI 1.19-1.42; p < 0.001), 2.01 (OR 2.01, 95% CI 1.62-2.50; p < 0.001) and 1.88 (OR 1.88, 95% CI 0.58-6.12; p = 0.29) times increased odds of readmission for THA, TKA and TSA, respectively exhibited 1.70 (OR 1.70, 95% CI 1.22-2.38 p = 0.002), 2.67 (OR 2.67, 95% CI 1.38-5.16; p = 0.003) and 3.60 (OR 3.60, 95% CI 1.84-7.03; p = 0.0002) times increased odds of reoperation for THA, TKA and TSA,, and respectively exhibited 6.06 (OR 6.06, 95% CI 2.05-17.90; p = 0.001), 3.96 (OR 3.96, 95% CI 1.78-8.83; p = 0.0008) and 14.21 (OR 14.57, 95% CI 2.10-101.14; p = 0.007) times increased odds of mortality for THA, TKA and TSA.

CONCLUSION

Although serum albumin predicts post-TJA readmission, reoperation and mortality, the large variation in risk requires investigation of procedure and population specific thresholds for hypoalbuminemia.