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Hypoalbuminemia Is an Independent Risk Factor for 30-Day Mortality, Postoperative Complications, Readmission, and Reoperation in the Operative Lower Extremity Orthopaedic Trauma Patient.

Publication ,  Journal Article
Wilson, JM; Lunati, MP; Grabel, ZJ; Staley, CA; Schwartz, AM; Schenker, ML
Published in: J Orthop Trauma
June 2019

INTRODUCTION: Malnutrition, as indicated by hypoalbuminemia, is known to have detrimental effects on outcomes after arthroplasty, geriatric hip fractures, and multiple general surgeries. Hypoalbuminemia has been examined in the critically ill but has largely been ignored in the orthopaedic trauma literature. We hypothesized that admission albumin levels would correlate with postoperative course in the nongeriatric lower extremity trauma patient. METHODS: Patients with lower extremity (including pelvis and acetabulum) fracture who underwent operative intervention were collected from the ACS-NSQIP database. Patients younger than 65 years were included. Patient demographic data, complications, length of stay, reoperation rate, and readmission rate were collected, and patient modified frailty index scores were calculated. Poisson regression with robust error variance was then conducted, controlling for potential confounders. RESULTS: Five thousand six hundred seventy-three patients with albumin available were identified, and 29.6% had hypoalbuminemia. Hypoalbuminemic patients had higher rates of postoperative complications [9.3% vs. 2.6%; relative risk (RR) 1.63] including increased rates of: mortality (3.2% vs. 0.4%; RR 4.86, 95% confidence interval 2.66-8.87), sepsis (1.5% vs. 0.5%, RR 2.35), and reintubation (2.3% vs. 0.4%; RR 3.84). Reoperation (5.5% vs. 2.6%, RR 1.74) and readmission (11.4% vs. 4.1%; RR 2.53) rates were also higher in patients with low albumin. CONCLUSION: Hypoalbuminemia is a powerful predictor of acute postoperative course and mortality after surgical fixation in nongeriatric, lower extremity orthopaedic trauma patients. Admission albumin should be a routine part of the orthopaedic trauma workup. Further study into the utility of supplementation is warranted, as this may represent a modifiable risk factor. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Published In

J Orthop Trauma

DOI

EISSN

1531-2291

Publication Date

June 2019

Volume

33

Issue

6

Start / End Page

284 / 291

Location

United States

Related Subject Headings

  • Young Adult
  • Risk Factors
  • Reoperation
  • Postoperative Complications
  • Patient Readmission
  • Orthopedics
  • Orthopedic Procedures
  • Middle Aged
  • Male
  • Hypoalbuminemia
 

Citation

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ICMJE
MLA
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Wilson, J. M., Lunati, M. P., Grabel, Z. J., Staley, C. A., Schwartz, A. M., & Schenker, M. L. (2019). Hypoalbuminemia Is an Independent Risk Factor for 30-Day Mortality, Postoperative Complications, Readmission, and Reoperation in the Operative Lower Extremity Orthopaedic Trauma Patient. J Orthop Trauma, 33(6), 284–291. https://doi.org/10.1097/BOT.0000000000001448
Wilson, Jacob M., Matthew P. Lunati, Zachary J. Grabel, Christopher A. Staley, Andrew M. Schwartz, and Mara L. Schenker. “Hypoalbuminemia Is an Independent Risk Factor for 30-Day Mortality, Postoperative Complications, Readmission, and Reoperation in the Operative Lower Extremity Orthopaedic Trauma Patient.J Orthop Trauma 33, no. 6 (June 2019): 284–91. https://doi.org/10.1097/BOT.0000000000001448.
Wilson, Jacob M., et al. “Hypoalbuminemia Is an Independent Risk Factor for 30-Day Mortality, Postoperative Complications, Readmission, and Reoperation in the Operative Lower Extremity Orthopaedic Trauma Patient.J Orthop Trauma, vol. 33, no. 6, June 2019, pp. 284–91. Pubmed, doi:10.1097/BOT.0000000000001448.

Published In

J Orthop Trauma

DOI

EISSN

1531-2291

Publication Date

June 2019

Volume

33

Issue

6

Start / End Page

284 / 291

Location

United States

Related Subject Headings

  • Young Adult
  • Risk Factors
  • Reoperation
  • Postoperative Complications
  • Patient Readmission
  • Orthopedics
  • Orthopedic Procedures
  • Middle Aged
  • Male
  • Hypoalbuminemia