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Zink TM, Kent SE, Choudhary AN, Kavolus JJ. Nutrition in Surgery: An Orthopaedic Perspective. J Bone Joint Surg Am 2023; 105:1897-1906. [PMID: 37856576 DOI: 10.2106/jbjs.23.00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
➤ Malnutrition is common among subsets of patients undergoing orthopaedic surgery and is associated with an increased risk of postoperative complications.➤ Serum proteins, in particular, albumin, may be used in the evaluation of nutritional status.➤ Anthropometric measurements and surveys also play a role in the evaluation of nutritional status.➤ Increased energy and nutrient requirements due to surgical procedures necessitate increased caloric and protein intake in the perioperative period, which may be achieved through diet or supplementation.➤ Evidence supports the use of protein-calorie, amino acid, and immunonutrition supplements. Vitamin D supplementation is an area of further consideration.➤ Diet restriction, activity alterations, pharmacotherapy, and bariatric surgery are all safe, effective approaches to weight loss, although the optimal timing and magnitude of preoperative weight loss require further investigation.
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Affiliation(s)
- Thomas M Zink
- Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Suzanne E Kent
- Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | | | - Joseph J Kavolus
- Tufts University School of Medicine, Boston, Massachusetts
- Newton-Wellesley Orthopedic Associates, Newton, Massachusetts
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Pes M, Pulino A, Pisanu F, Manunta AF. Why malnutrition in orthopaedic elective patient is still an issue? A recent review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3723-3727. [PMID: 37256389 PMCID: PMC10651696 DOI: 10.1007/s00590-023-03593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/14/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Malnutrition is a known risk factor for complications and adverse outcomes after elective total joint arthroplasty (TJA). The progressive increase in the ageing of world population and in the numbers of TJA, widens the demand for a faster post-operative recovery and function. The aim of this study was to review the literature regarding: post-operative transfusion, infections, wound complications, length of hospital stay (LOS), rate of admission in intensive care unit (ICU), and total patient charges, in malnourished patient undergoing TJA. METHODS The search reviewed all fields of the available peer-reviewed literature, published in the English language during the last seven years 2015-2022. We started from a total of 745 studies and finally we included in the review 16 articles. RESULTS In 10 studies, an increased surgical site infection was shown, being by far the most common complication, in 8 studies, malnutrition was associate with the increase of the average length of stay (LOS), and in 5 studies, the major founding was the increase in costs. An increase of the morbidity was found in 3 studies, instead a larger number of transfusions was highlighted in 2 studies. Lastly, one study showed a major unplanned ICU admission rate. CONCLUSIONS Although the literature trend indicates that the nutritional status of TJA candidate patients is a parameter that influences the surgical outcome, in particular surgical site infections, length of stay, and costs, there are, to the authors' knowledge, no studies aimed at identifying validated and recognized protocols for the correction of malnutrition.
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Affiliation(s)
- Marco Pes
- Orthopaedic Department, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
| | - Alessio Pulino
- Orthopaedic Department, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Francesco Pisanu
- Orthopaedic Department, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Andrea Fabio Manunta
- Orthopaedic Department, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
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Wu Z, Liu C, Ma Z, Li Z, Wang S, Chen Y, Han M, Huang S, Zhou Q, Zhang C, Hou B. A hierarchical prognostic model for Co-diabetes pancreatic adenocarcinoma. Heliyon 2023; 9:e21642. [PMID: 38027595 PMCID: PMC10663840 DOI: 10.1016/j.heliyon.2023.e21642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Co-diabetes pancreatic adenocarcinoma has a poorer prognosis than pancreatic adenocarcinoma without diabetes. This study aimed to develop a reliable prognostic model for patients with co-diabetes pancreatic adenocarcinoma. Method Overall, 169 patients with co-diabetes pancreatic adenocarcinoma were included in our study. First, the independent risk factors affecting the prognosis of patients with co-diabetes pancreatic adenocarcinoma were determined by univariate and multivariate Cox regression analyses. Based on these identified risk factors, we developed a nomogram and evaluated its predictive ability using the concordance index, receiver operating characteristic curve, calibration plot, decision curve, and net reclassification index. Results In this study, prealbumin, transferrin, carcinoembryonic antigen, distant metastasis, tumor differentiation neutrophil count, lymphocyte count and fasting blood glucose were confirmed as significant prognostic factors. Based on these predictors, a new nomogram was developed. Compared with the American Joint Committee on Cancer 8 staging system and other models, the nomogram achieved a higher concordance index in the training (0.795) and validation (0.729) queues. The area under the nomogram's curve for predicting patient survival at 0.5, 1, and 1.5 years in the training queue was >0.8. Patients were risk-stratified using the nomogram, and Kaplan-Meier survival curves of subgroups were plotted. The Kaplan-Meier curve also showed better separation than the American Joint Committee on Cancer 8 staging system, indicating that our model has a better risk hierarchical ability. Conclusions Compared to the American Joint Committee on Cancer 8 staging system and other predictive models, our model showed better predictive ability for patients with co-diabetes pancreatic adenocarcinoma. Our model will help in patients' risk stratification and improves their prognosis.
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Affiliation(s)
- Zelong Wu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
| | - Chunsheng Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
| | - Zuyi Ma
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100005, China
| | - Zhenchong Li
- German Cancer Research Center (DKFZ), Junior Clinical Cooperation Unit Translational Gastrointestinal Oncology and Preclinical Models, Heidelberg, Germany
| | - Shujie Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Heyuan People's Hospital, Heyuan 517000, China
| | - Yubin Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Heyuan People's Hospital, Heyuan 517000, China
- South China University of Technology School of Medicine, Guangzhou 51000, China
| | - Mingqian Han
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
| | - Shanzhou Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
- South China University of Technology School of Medicine, Guangzhou 51000, China
| | - Qi Zhou
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
- Department of General Surgery, Hui Ya Hospital of the First Affiliated Hospital, Sun Yat-sen University, Huizhou, Guangdong 516081, China
| | - Chuanzhao Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
- South China University of Technology School of Medicine, Guangzhou 51000, China
| | - Baohua Hou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Heyuan People's Hospital, Heyuan 517000, China
- South China University of Technology School of Medicine, Guangzhou 51000, China
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Li D, Ding S, Li J, Liao X, Ru K, Liu L, Shang W. Diagnostic value of inflammatory indicators for surgical site infection in patients with breast cancer. Front Cell Infect Microbiol 2023; 13:1286313. [PMID: 37953798 PMCID: PMC10634473 DOI: 10.3389/fcimb.2023.1286313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023] Open
Abstract
Background Breast cancer is the most commonly diagnostic cancer in women worldwide. The main treatment for these patients is surgery. However, there is a high incidence of surgical site infection (SSI) in breast cancer patients. The aim of this study was to identify effective infection-related diagnostic markers for timely diagnosis and treatment of SSI. Methods This retrospective study included 263 breast cancer patients who were treated between July 2018 and March 2023 at the Shandong Cancer Hospital and Institute. We analyzed differences between the SSI group and control group and differences before and during infection in the SSI group. Finally, we tested the distribution of pathogenic microorganisms and their susceptibility to antibiotics. Results Compared with preoperative inflammatory indicators, white blood cells (WBC), neutrophils (NEU), absolute neutrophil count to the absolute lymphocyte count (NLR), D2 polymers (D-Dimer) and fibrinogen (FIB) were significantly increased, while lymphocytes (LYM), albumin (ALB) and prealbumin (PA) were significantly decreased in the SSI group. Compared with uninfected patients, WBC, NEU, NLR and FIB were significantly increased, ALB and PA were significantly decreased in SSI patients, while LYM and D-Dimer did not differ significantly. The distribution of infection bacteria in SSI patients showed that the proportion of patients with Staphylococcus aureus infection was as high as 70.41%; of those patients, 19.33% had methicillin-resistant Staphylococcus aureus (MRSA) infection. The area under the curves (AUCs) of the receiver operating curves (ROCs) for WBC, NEU, NLR, FIB, ALB and PA were 0.807, 0.811, 0.730, 0.705, 0.663 and 0.796, respectively. The AUCs for other inflammatory indicators were not statistically significant. There was no significant difference in antibiotic resistance for Staphylococcus aureus when compared to that of gram-positive bacteria. The resistance of gram-positive bacteria to ceftriaxone (CRO), cefoxitin (FOX), chloramphenicol (CHL), minocycline (MNO) and tetracycline (TCY) was lower than that of gram-negative bacteria, while the resistance to gentamicin (GEN) was higher. Conclusion This study demonstrated that WBC, NEU, NLR, FIB and PA have good predictive value for identifying patients at risk of SSI. The cut-off values of inflammatory indicators can be helpful in the prevention and diagnosis of SSI.
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Affiliation(s)
| | | | | | | | | | | | - Wenjing Shang
- Department of Clinical Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
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Zhang F, Huang L, Li M, Quan Z, Wang Y, Luo H, Liu J, Wang J. Effect of Pre-Operative Low Serum Pre-Albumin on Surgical Site Infection in Post-Surgery Subjects: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2023; 24:684-691. [PMID: 37831925 DOI: 10.1089/sur.2023.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Abstract
Background: The correlation between pre-operative serum pre-albumin and surgical site infection (SSI) has been the focus of many studies. However, existing literature presents conflicting evidence on this association. Therefore, this meta-analysis was conducted to determine the significance of low serum pre-albumin as a prognostic factor SSI, and to assess the potential utility of pre-albumin in predicting SSI. Methods: A comprehensive literature search and analysis was conducted in PubMed, Web of Science, Cochrane of Library, Scopus, Embase, and Google Scholar databases through August 2022 to identify studies reporting low pre-operative serum pre-albumin levels in patients undergoing surgery and their association with SSIs. The pooled risk estimates were shown in odds ratio with 95% confidence interval. The random effect model was used according to the test of heterogeneity among studies. Subgroup analyses and sensitivity analyses were performed to identify the possible sources of heterogeneity. This meta-analysis was prospectively registered in the PROSPERO database (number: CRD42022376167). Results: Nine studies involving 5,306 patients were eligible. The results demonstrated an association between low pre-operative serum pre-albumin levels and a higher probability of developing SSI (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.28-3.26). Conclusions: Our findings suggest that low serum pre-albumin level may serve as an independent and valuable predictor of SSI. These results provide important insights for clinicians in identifying high-risk patients and implementing preventive measures.
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Affiliation(s)
- Fei Zhang
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Letian Huang
- Department of Oncology, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - MingLin Li
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ziwei Quan
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yifei Wang
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hanyong Luo
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jiye Liu
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
- Department of Rehabilitation Medicine, Huludao Central Hospital, Huludao, Liaoning Province, China
| | - Jiahe Wang
- Department of Family Medicine, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Jaqueto PA, Sabbag IC, Silva LPDA, Nunes LFB, Mattos CADE, Leandro-Merhi VA. INVERSE RELATIONSHIP BETWEEN PLASMA PROTEINS AND SATISFACTORY SURGICAL WOUNDS OUTCOME. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e263313. [PMID: 37323150 PMCID: PMC10263440 DOI: 10.1590/1413-785220233102e263313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/05/2022] [Indexed: 06/17/2023]
Abstract
Objective This study investigated the factors associated with satisfactory early postoperative wound conditions. Method A prospective study was conducted with patients (n=179) submitted to osteosynthesis in general, in a hospital orthopedics service. In the preoperative period, patients underwent laboratory exams and the surgical indications were based on the type of fracture and the patient's clinical conditions. In the postoperative period, patients were evaluated based on the presence of complications and considering their surgical wounds. Chi-square, Fisher, Mann-Whitney, and Kruskal-Wallis tests were used in the analysis. To identify the factors associated with wound condition, univariate and multiple logistic regression analysis was used. Results In the univariate analysis, each transferring unit reduction increased the chance of satisfactory outcome by 1.1% (p=0.0306; OR= 0.989 (1.011); 95%CI= 0.978;0.999; 1.001;1.023). The presence of SAH increased 2.7 fold the chance of satisfactory outcome (p=0.0424; OR= 2,667; 95%CI= 1,034;6,877). Hip fracture increased 2.6 fold the chance of satisfactory outcome (p=0.0272; OR=2.593; IC95%=1.113; 6.039). And the absence of a compound fracture increased 5.5 fold the chance of satisfactory wound outcome (p=0.0004; OR=5,493; 95%CI=2,132;14,149). In the multiple analysis, patients with non compound fractures were 9.7 times more likely to experience a satisfactory outcome when compared to patients with compound fractures (p=0.0014; OR=9,687; 95%CI= 2,399; 39,125). Conclusion There was an inverse relationship between plasma proteins levels and satisfactory surgical wounds outcome. Only exposure remained associated with wound conditions. Level Of Evidence: II, Prospective Study.
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Affiliation(s)
- Pedro Augusto Jaqueto
- . Pontifícia Universidade Católica de Campinas (PUC-Campinas), Postgraduated Program in Health Sciences, Campinas, SP, Brazil
| | | | | | | | | | - Vânia Aparecida Leandro-Merhi
- . Pontifícia Universidade Católica de Campinas (PUC-Campinas), Postgraduated Program in Health Sciences, Campinas, SP, Brazil
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Elliott Holbert S, Brennan JC, Johnson AH, Turcotte JJ, King PJ, MacDonald JH. The effects of hypoalbuminemia in obese patients undergoing total joint arthroplasty. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04786-1. [PMID: 36773048 DOI: 10.1007/s00402-023-04786-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/22/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Total joint arthroplasty (TJA) is a highly effective surgery. However, poor nutritional status has been associated with worse outcomes. In orthopedics, nutrition status is commonly evaluated using serum albumin. When albumin levels fall below 3.0 g/dL, wound healing ability becomes impaired. Typically, malnutrition is associated with low BMI, but malnourished patients can also be obese. The goals of this study were to investigate the relationship between malnourishment represented through albumin levels of obese patients and likelihood of postoperative complications. METHODS A retrospective review of patients undergoing primary TJA from 2016 to 2020 in the American College of Surgeons National Surgical Quality Improvement Program national database was performed. Patients with an albumin of < 3.5 g/dL were considered to have hypoalbuminemia and those with ≥ 3.5 g/dL were considered normal albumin. Univariate analysis was used to determine demographic and comorbidity differences between those with and without hypoalbuminemia. Outcomes of interest included length of stay, resource utilization, discharge disposition, and unplanned readmissions. Multivariate logistic regression examined albumin as a predictor of increased resource utilization and complications after controlling for possible confounding variables. RESULTS Of the 79,784 patients, 4.96% of patients had low albumin. Those with hypoalbuminemia were nearly 1.5 years older than those with normal albumin, were more likely to be black, female, and had an overall increased comorbidity burden as shown by percent of patients with ASA > 3 (all p < 0.001). After risk adjustment, those with hypoalbuminemia and a BMI of 35 + had greater risk of complications and increased resource utilization. CONCLUSION Our results demonstrated the prevalence of malnutrition increases as a patient's BMI increases. Further, hypoalbuminemia was associated with increased resource utilization and increased complication rates in all obese patients. We suggest screening albumin levels in obese patients preoperatively to give surgeons the best opportunity to optimize patient nutrition before undergoing surgery.
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Affiliation(s)
- S Elliott Holbert
- Anne Arundel Medical Center, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
| | - Jane C Brennan
- Anne Arundel Medical Center, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
| | - Andrea H Johnson
- Anne Arundel Medical Center, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
| | - Justin J Turcotte
- Anne Arundel Medical Center, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA.
| | - Paul J King
- Anne Arundel Medical Center, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
| | - James H MacDonald
- Anne Arundel Medical Center, 2000 Medical Parkway, Suite 503, Annapolis, MD, 21401, USA
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Li W, Yang Y, Li Z, Chen W. Effect of malnutrition and nutritional support to reduce infections in elderly hospitalized patients with cancer: A multicenter survey in China. Nutrition 2023; 106:111894. [PMID: 36459844 DOI: 10.1016/j.nut.2022.111894] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/11/2022] [Accepted: 10/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Malnutrition is common among elderly patients with cancer, and greatly affects patients' quality of life. Malnutrition is a key factor in the development of systemic, chronic, low-grade inflammation that can exacerbate. METHODS A total of 633 elderly patients with cancer from 29 tertiary public hospitals in 14 cities in China were selected as the research subjects. Physical examination, questionnaire survey, medical history collection, and blood index detection were performed on the research subjects to analyze the relationship between malnutrition, nutritional support, and infection status. RESULTS There was no significant difference in infection rate among elderly hospitalized patients with cancer and different cancer types, cancer stages, or therapy methods (P > 0.05). The proportion of vomiting, loss of appetite, depression, and physical fatigue in patients with good nutritional status were lower than in patients with moderate or severe malnutrition (P < 0.05). Nutritional support is crucial for the nutritional status of elderly patients with cancer, and patients without special nutritional guidance are more likely to develop infection (P < 0.05). After adjusting for confounding variables, the results of the logistic regression analysis showed that oral nutritional supplements (odds ratio [OR]: 0.088; 95% confidence interval [CI], 0.015-0.514), parenteral nutrition (OR: 0.091; 95% CI, 0.011-0.758), and individualized nutritional guidance (OR: 0.026; 95% CI, 0.003-0.202) were all protective factors associated with cancer infection. CONCLUSIONS Many elderly hospitalized patients with cancer have local or systemic infections, and good nutrition is associated with lower rates of infection. Receiving nutritional guidance or support is associated with lower infection rates in elderly patients with cancer.
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Affiliation(s)
- Wanyang Li
- Department of Clinical Nutrition, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaming Yang
- Department of Nutrition, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zijian Li
- Department of General Surgery, Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Chen
- Department of Clinical Nutrition, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Nutritional Biomarkers and Heart Rate Variability in Patients with Subacute Stroke. Nutrients 2022; 14:nu14245320. [PMID: 36558479 PMCID: PMC9784051 DOI: 10.3390/nu14245320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Malnutrition and autonomic dysfunction are associated with poor outcomes, mortality, and psychological problems after stroke. Relevant laboratory biomarkers include serum albumin, prealbumin, and transferrin. Heart rate variability (HRV), a noninvasive measurement, can objectively measure autonomic nervous system (ANS) function. The relationship between HRV and nutritional biomarkers in stroke patients has not been studied. This study aimed to examine the relationship between nutritional biomarkers and HRV parameters in stroke patients. We retrospectively recruited 426 patients with subacute stroke who were examined for nutritional biomarkers, such as serum albumin, prealbumin, and transferrin, and underwent 24 h ambulatory Holter electrocardiography. Patients were divided into groups according to their nutritional biomarker status. Differences in HRV parameters between nutritional biomarker-deficient and normal groups were assessed. Pearson's correlation and multiple regression analyses were used to verify the relationship between HRV parameters and nutritional biomarkers. HRV parameters were significantly lower in the nutritional biomarker-deficient groups. In addition, there was a significant association between HRV parameters and nutritional biomarkers. Serum albumin, prealbumin, and transferrin levels were associated with ANS function, as measured by HRV, and their deficiency may be a predictive factor for the severity of ANS dysfunction in stroke patients.
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10
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Tfaily MA, Ghanem P, Farran SH, Dabdoub F, Kanafani ZA. The role of preoperative albumin and white blood cell count in surgical site infections following whipple surgery. Sci Rep 2022; 12:19184. [PMID: 36357432 PMCID: PMC9649662 DOI: 10.1038/s41598-022-21849-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
Whipple surgery is associated with a high risk of surgical sites infections (SSIs). Nutritional deficiency has been associated with an increased risk of wound infections. This study aims at exploring the role of preoperative albumin levels in predicting the risk of SSIs following Whipple surgery. A total of 23,808 individuals were identified from the ACS-NSQIP database from years 2011 to 2017. The primary exposure was pre-operative albumin while the secondary exposure was white blood cell (WBC) count. The primary outcome was divided into superficial and deep surgical site infections (S/D SSI) and organ-space SSI. All statistical analyses were conducted using IBM Statistical Package for Social Sciences version 26. Levels of pre-operative serum albumin less than 3.73 g/L, dirty and contaminated wounds and longer operative time were associated with increased odds for developing S/D SSIs (OR = 1.14, OR = 1.17, OR = 1.06, respectively, p-value < 0.05). Pre-operative WBC level (/L) was associated with a risk of developing an organ-space SSI but not S/D SSI (OR = 1.02, p-value 0.003). This study demonstrates the predictive role of pre-operative albumin in developing S/D SSIs and highlights the need to develop therapeutic strategies to optimize the pre-operative nutritional health status of patients undergoing Whipple surgery.
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Affiliation(s)
- Mohamad Ali Tfaily
- grid.189967.80000 0001 0941 6502Department of Internal Medicine, Emory University, Atlanta, GA USA ,grid.411654.30000 0004 0581 3406Department of Internal Medicine, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon
| | - Paola Ghanem
- grid.21107.350000 0001 2171 9311Department of Medical Oncology, Johns Hopkins University, Baltimore, MD USA
| | - Sarah H. Farran
- grid.22903.3a0000 0004 1936 9801Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Fatema Dabdoub
- grid.411654.30000 0004 0581 3406Department of Internal Medicine, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon
| | - Zeina A. Kanafani
- grid.411654.30000 0004 0581 3406Department of Internal Medicine, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon
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Dubé MD, Rothfusz CA, Emara AK, Hadad M, Surace P, Krebs VE, Molloy RM, Piuzzi NS. Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty: a Detailed Review and Guide to Management. Curr Rev Musculoskelet Med 2022; 15:311-322. [PMID: 35501548 DOI: 10.1007/s12178-022-09762-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW 8.5 to 50% of total joint arthroplasty (TJA) patients are reported to have preoperative malnutrition. The narrative review identifies the relationship between preoperative malnutrition for TJA patients and postoperative outcomes as well as the use of perioperative nutritional intervention to improve postoperative complications. RECENT FINDINGS Biochemical/laboratory, anthropometric, and clinical measures have been widely used to identify preoperative nutritional deficiency. Specifically, serum albumin is the most prevalent used marker in TJA because it has been proven to be correlated with protein-energy malnutrition due to the surgical stress response. However, there remains a sustained incidence of preoperative malnutrition in total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients due to a lack of agreement among the available nutritional screening tools and utilization of isolated laboratory, anthropometric, and clinical variables. Previous investigations have also suggested preoperative malnutrition to be a prognostic indicator of complications in general, cardiac, vascular, and orthopaedic surgery specialties. Serum albumin, prealbumin, transferrin, and total lymphocyte count (TLC) can be used to identify at-risk patients. It is important to employ these markers in the preoperative setting because malnourished TKA and THA patients have shown to have worse postoperative outcomes including prolonged length, increased reoperation rates, increased infection rates, and increased mortality rates. Although benefits from high-protein and high-anti-inflammatory diets have been exhibited, additional research is needed to confirm the use of perioperative nutritional intervention as an appropriate treatment for preoperative TJA patients.
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Affiliation(s)
- Michael D Dubé
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | | | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Matthew Hadad
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Peter Surace
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA.
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Huang J, Tian L, Wang B. Predictive value of postoperative serum prealbumin levels for early detection of anastomotic leak after esophagectomy: A retrospective study. Medicine (Baltimore) 2022; 101:e29201. [PMID: 35512077 PMCID: PMC9276443 DOI: 10.1097/md.0000000000029201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/11/2022] [Indexed: 01/04/2023] Open
Abstract
The impact of serum prealbumin in patients with esophageal carcinoma after undergoing esophagectomy remains unclear, we speculated that serum prealbumin is associated with anastomotic leak (AL) after surgery, low serum prealbumin level may lead to AL. The aim of the study was to evaluate the relationship between serum prealbumin levels and AL after esophagectomy, to explore the value of serum prealbumin as an early predictor of AL after esophagectomy.Between January 2014 and December 2018, 255 patients were enrolled in this study, their basic characteristics and perioperative serum prealbumin levels were retrospectively analyzed. Statistical analysis by t test, nonparametric test and logistic regression were used to analyze data for patients with and without AL. Based on a receiver operator characteristic curve, a cut-off value for serum prealbumin levels as a predictor of AL was determined.Among the 255 patients, 18 patients were diagnosed with AL. The overall AL rate was 7.0% (18/255) including 12 cases of intrathoracic AL and 6 cases of cervical AL. By univariate analysis, we identified postoperative serum prealbumin level as a risk factor for AL (P < .001). Multivariate analysis also demonstrated postoperative serum prealbumin level (P = .028) to be an independent risk factor for AL. The best cut-off value of postoperative serum prealbumin level was 131 mg/L for predicting AL, with 83.3% sensitivity and 72.2% specificity.Postoperative serum prealbumin level was significantly associated with AL. it may help the early prediction of postoperative AL.
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Emara AK, Hadad MJ, Dube M, Klika AK, Burguera B, Piuzzi NS. Team Approach: Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty. JBJS Rev 2022; 10:01874474-202203000-00001. [PMID: 35230998 DOI: 10.2106/jbjs.rvw.21.00138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Nutritional assessment is a critical element of routine preoperative assessment and should be approached by an interdisciplinary team that involves the primary care physician, dietitian, and orthopaedist. » Patients should be stratified on the basis of their nutritional risk, which influences downstream optimization and deficiency reversal. » The scientific literature indicates that nutritional supplementation affords protection against adverse outcomes and helps functional recovery, even among patients who are not at nutritional risk. » Published investigations recommend a sufficient preoperative interval (at least 4 weeks) to ensure an adequate nutritional intervention in malnourished patients as opposed to regarding them as nonsurgical candidates.
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Affiliation(s)
- Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew J Hadad
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael Dube
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.,Northeast Ohio Medical University, Rootstown, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bartolome Burguera
- Department of Endocrinology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Hur ES, Bohl DD, Della Valle CJ, Villalobos F, Gerlinger TL. Hypoalbuminemia Predicts Adverse Events following Unicompartmental Knee Arthroplasty. J Knee Surg 2021; 36:491-497. [PMID: 34768290 DOI: 10.1055/s-0041-1739146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hypoalbuminemia is a potentially modifiable risk factor associated with adverse events following total knee arthroplasty. The present study aimed to evaluate whether hypoalbuminemia similarly predisposes to adverse events following unicompartmental knee arthroplasty (UKA). Patients who underwent UKA during 2006-2018 were identified through the American College of Surgeons National Surgical Quality Improvement Program. Only patients with preoperative serum albumin concentration were included. Outcomes were compared between patients with and without hypoalbuminemia (serum albumin concentration < 3.5 g/dL). All associations were adjusted for demographic, comorbidity, and laboratory differences between populations. A total of 11,342 patients were identified, of whom 6,049 (53.3%) had preoperative serum albumin laboratory values available for analysis. After adjustment for potential confounders, patients with hypoalbuminemia had a greater than 2-fold increased probability for occurrence of any complication (7.02% vs. 2.23%, p = 0.009) and a 4-fold increased probability of receiving a blood transfusion (1.81% vs. 0.25%, p = 0.045). Among procedures performed as inpatients, mean postoperative length of stay (LOS) was longer in patients with hypoalbuminemia (2.2 vs. 1.8 days; p = 0.031). Hypoalbuminemia is independently associated with complications and increased LOS following UKA and a marker for patients at higher risk of postoperative complications. Patients should be screened for hypoalbuminemia and nutritional deficiencies addressed prior to UKA.
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Affiliation(s)
- Edward S Hur
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Felipe Villalobos
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Tad L Gerlinger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Malnutrition in elective shoulder arthroplasty: a multi-institutional retrospective study of preoperative albumin and adverse outcomes. J Shoulder Elbow Surg 2021; 30:2491-2497. [PMID: 33819566 DOI: 10.1016/j.jse.2021.03.143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Malnutrition is associated with poor postoperative outcomes after knee, hip, and spine surgery. However, whether albumin labs should be part of the routine preoperative workup for shoulder arthroplasty remains understudied. This study investigated the role of preoperative albumin levels in predicting common postoperative adverse outcomes in patients undergoing shoulder arthroplasty. METHODS All shoulder arthroplasty cases performed at 2 tertiary referral centers between July 2013 and May 2019 (institution 1) and between June 2007 and Feb 2020 (institution 2) were reviewed. A total of 421 primary and 71 revision elective shoulder arthroplasty cases had preoperative albumin levels recorded. Common demographic variables and relevant Elixhauser comorbidities were pulled. Outcomes gathered included extended (>3 days) postoperative inpatient length of stay (eLOS), 90-day readmission, and discharge to rehab or skilled nursing facility (SNF). RESULTS The prevalence of malnutrition (albumin <3.5 g/dL) was higher in the revision group compared with the primary group (36.6% vs. 19.5%, P = .001). Reverse shoulder arthroplasty (P = .013) and increasing American Society of Anesthesiologists score (P = .016) were identified as independent risk factors for malnutrition in the primary group. In the revision group, liver disease was associated with malnutrition (P = .046). Malnourished primary shoulder arthroplasty patients had an increased incidence of eLOS (26.8% vs. 13.6%, P = .003) and discharge to rehab/SNF (18.3% vs. 10.3%, P = .045). On univariable analysis, low albumin had an odds ratio (OR) of 2.34 for eLOS (P = .004), which retained significance in a multivariable model including age, American Society of Anesthesiologists score, sex, and body mass index (OR 2.11, P = .03). On univariable analysis, low albumin had an OR of 1.94 for discharge to SNF/rehab (P = .048), but this did not reach significance in the multivariable model. Among revisions, malnourished patients had an increased incidence of eLOS (30.8% vs. 6.7%, P = .014) and discharge to rehab/SNF (26.9% vs. 4.4%, P = .010). In both the primary and revision groups, there was no difference in 90-day readmission rate between patients with low or normal albumin. CONCLUSION Malnutrition is more prevalent among revision shoulder arthroplasty patients compared with those undergoing a primary procedure. Primary shoulder arthroplasty patients with low preoperative albumin levels have an increased risk of eLOS and may have an increased need for postacute care. Low albumin was not associated with a risk of 90-day readmissions. Albumin level merits further investigation in large, prospective cohorts to clearly define its role in preoperative risk stratification.
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Handcox JE, Gutierrez-Naranjo JM, Salazar LM, Bullock TS, Griffin LP, Zelle BA. Nutrition and Vitamin Deficiencies Are Common in Orthopaedic Trauma Patients. J Clin Med 2021; 10:5012. [PMID: 34768533 PMCID: PMC8584741 DOI: 10.3390/jcm10215012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Macro- and micronutrients play important roles in the biological wound-healing pathway. Although deficiencies may potentially affect orthopaedic trauma patient outcomes, data on nutritional deficiencies in orthopaedic trauma patients remain limited in the literature. The purpose of this study was to (1) evaluate the prevalence of macro- and micronutrient deficiencies in orthopaedic trauma patients with lower extremity fractures and (2) evaluate the impact of such deficiencies on surgical site complications. This retrospective study identified 867 patients with lower extremity fractures treated with surgical fixation from 2019 to 2020. Data recorded included albumin, prealbumin, protein, vitamins A/C/D, magnesium, phosphorus, transferrin and zinc, as well as wound complications. Nutritional deficiencies were found for prealbumin, albumin and transferrin at 50.5%, 23.4% and 48.5%, respectively. Furthermore, a high prevalence of micronutrient deficiencies (vitamin A, 35.4%; vitamin C, 54.4%; vitamin D, 75.4%; and zinc, 56.5%) was observed. We also recorded a statistically significant difference in wound complications in patients who were deficient in prealbumin (21.6% vs. 6.6%, p = 0.0142) and vitamin C (56.8% vs. 28.6%, p = 0.0236). Our study outlines the prevalence of nutritional deficiencies in an orthopaedic trauma population and identifies areas for possible targeted supplementation to decrease wound complications.
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Affiliation(s)
- Jordan E. Handcox
- Department of Orthopaedics, UT Health San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA; (J.E.H.); (J.M.G.-N.); (T.S.B.)
| | - Jose M. Gutierrez-Naranjo
- Department of Orthopaedics, UT Health San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA; (J.E.H.); (J.M.G.-N.); (T.S.B.)
| | - Luis M. Salazar
- Long School of Medicine, UT Health San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA;
| | - Travis S. Bullock
- Department of Orthopaedics, UT Health San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA; (J.E.H.); (J.M.G.-N.); (T.S.B.)
| | - Leah P. Griffin
- Medical Solutions Division, 3M Health Care, San Antonio, TX 78249, USA;
| | - Boris A. Zelle
- Department of Orthopaedics, UT Health San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA; (J.E.H.); (J.M.G.-N.); (T.S.B.)
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Yamane T, Sawayama H, Yoshida N, Morinaga T, Akiyama T, Eto K, Harada K, Ogawa K, Iwatsuki M, Iwagami S, Baba Y, Miyamoto Y, Baba H. Preoperative transferrin level is a novel indicator of short- and long-term outcomes after esophageal cancer surgery. Int J Clin Oncol 2021; 27:131-140. [PMID: 34586549 DOI: 10.1007/s10147-021-02031-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/14/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aimed to examine whether preoperative serum transferrin, a rapid-turnover protein, correlates with short- and long-term outcomes after esophagectomy. METHODS Preoperative transferrin levels, calculated by summing serum iron and unsaturated iron-binding capacity, were evaluated in 224 patients who underwent esophagectomy for stage I-III esophageal cancer without preoperative treatment. Transferrin levels are directly proportional to total iron-binding capacity (TIBC), and we defined TIBC < 250 μg/dL as low transferrin. We evaluated the relationship between preoperative transferrin levels and short- and long-term outcomes after esophagectomy using univariate and multivariate Cox proportional hazards analyses. RESULTS Of all patients, 25 (11.2%) had low preoperative transferrin levels. Low preoperative transferrin levels were strongly correlated with worse preoperative performance status, advanced pathological T stage, and more open esophagectomy (p = 0.0078, 0.0001, and 0.013, respectively). Patients with low preoperative transferrin levels experienced significantly more frequent postoperative pneumonia in univariate and multivariate analysis [hazard ratio (HR) 3.30, 95% confidence interval (CI) 1.032-10.033, p = 0.0443]. Additionally, these patients were significantly correlated with worse overall survival (OS) in univariate and multivariate analyses (HR 2.75, 95% CI 1.018-7.426, p = 0.0460). Furthermore, we investigated the relationship between OS and postoperative pneumonia to elucidate why low preoperative transferrin, which is an independent risk factor for postoperative pneumonia, leads to poor prognosis. Patients with postoperative pneumonia were strongly associated with a shorter OS (p = 0.0099). CONCLUSION Preoperative serum transferrin levels may be a novel indicator of postoperative pneumonia and OS after esophagectomy.
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Affiliation(s)
- Taishi Yamane
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hiroshi Sawayama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Takeshi Morinaga
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Takahiko Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kazuto Harada
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Katsuhiro Ogawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Li Y, Liu X, Jiang Y, Wan K, Liu W, Ou Y, Bai J, You Y, Hu F, Xu Z, Bie P, Zhang C, Zhang L. Low preoperative prealbumin predicts the prevalence of complications following liver transplantation. BMC Gastroenterol 2021; 21:233. [PMID: 34022800 PMCID: PMC8141182 DOI: 10.1186/s12876-021-01818-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background As a nutritional index, preoperative serum prealbumin highly correlates with surgical complications. However, the correlation between preoperative prealbumin and postoperative complications remains unclear in liver transplantation (LT). Methods A total of 191 patients who underwent LT between 2015 and 2019 were included in the retrospective analysis. According to a cut-off value calculated from a receiver operating characteristic (ROC) curve, the patients were divided into normal and low preoperative prealbumin groups. Univariable and multivariable logistic regression analyses were used to identify independent risk factors for postoperative complications. In addition, patients were divided into subgroups by Model for End-stage Liver Disease (MELD) score, and the association between preoperative prealbumin and postoperative complications was also assessed in each group. Results A total of 111 (58.1%) patients were included in the low prealbumin group based on a cut-off value of 120 mg/L. The area under the ROC curve (AUC) was 0.754 (95% confidence interval [CI] 0.678–0.832). Low prealbumin (95% CI 1.51–12.8, P = 0.007) was identified as a predictor for postoperative complications based on multivariable regression. In the low and normal prealbumin groups, the prevalence rates of postoperative complications were 27.5% and 8.0% (P = 0.003) in the MELD score ≤ 15 subgroup and 53.3% and 20.0% (P = 0.197) in the MELD score > 15 subgroup, respectively. Conclusions Preoperative prealbumin was associated with postoperative complications in LT, and preoperative nutritional support benefitted postoperative recovery, especially for patients with low MELD scores.
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Affiliation(s)
- Yuancheng Li
- College of Basic Medical Sciences, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xingchao Liu
- Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan, China
| | - Yan Jiang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Road, Chongqing, 400038, China
| | - Kun Wan
- Department of Medical Imagine, People's Liberation Army of China 949 Hospital, Xinjiang Military Hospital, Xinjiang, China
| | - Wei Liu
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Road, Chongqing, 400038, China
| | - Yanjiao Ou
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Road, Chongqing, 400038, China
| | - Jie Bai
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Road, Chongqing, 400038, China
| | - Yuemei You
- Department of Surgery and Anesthesiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Feng Hu
- College of Basic Medical Sciences, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zeliang Xu
- College of Basic Medical Sciences, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ping Bie
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Chengcheng Zhang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Road, Chongqing, 400038, China.
| | - Leida Zhang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Road, Chongqing, 400038, China.
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Preoperative Albumin, Transferrin, and Total Lymphocyte Count as Risk Markers for Postoperative Complications After Total Joint Arthroplasty: A Systematic Review. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e19.00057. [PMID: 33939393 PMCID: PMC7478613 DOI: 10.5435/jaaosglobal-d-19-00057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: The purpose of this systematic review is to identify whether poor nutrition, as defined by the more commonly used markers of low albumin, low transferrin, or low total lymphocyte count (TLC), leads to more postoperative complications. We hypothesized that it may be possible to identify the levels of these laboratory values at which point total joint arthroplasty (TJA) may be ill advised. To this end, we analyzed the available literature regarding links between these three variables on postoperative complications after TJA. Methods: This systematic review was done in two parts: (1) In the first part, we reviewed the most commonly used malnutrition marker, albumin. (2) In the second part, we reviewed TLC and transferrin. We accessed PubMed, EMBASE, and Cochrane Library using relevant keywords to this study. The biostatistics were visualized using a random-effects forest plot. We compared data from all articles with sufficient data on patients with complications (ie, cases) and patients without complications (ie, noncases) among the two groups, malnourished and normal nutrition, from albumin, transferrin, and TLC data. Results: A meta-analysis of seven large-scale articles detailing the complications of albumin led to an all-cause relative risk increase of 1.93 when operating with hypoalbuminemia. This means that in the studies detailed enough to incorporate in this pooled analysis, operating on elective TJAs with low albumin is associated with a 93% increase in all measured complications. In the largest studies, analysis of transferrin levels for the most common complications revealed a relative risk increase of 2.52 when operating on patients with low transferrin levels. There were not enough subjects to do a biostatistical analysis in articles using TLC as the definition of malnutrition. Conclusion: The focus is on the trends rather than absolutes. As shown in Table 1, whether the albumin cutoff for albumin was 3.0 g/dL, 3.5 g/dL, or 3.9 g/dL, the trend remains the same. Because low albumin before TJAs tends to increase complications, it is recommended to incorporate albumin levels in preoperative workups. Many patients with hip and knee arthritis undergo months of conservative management (eg, physical therapy and corticosteroid injections) before considering surgery, and it would be wise to optimize their nutritional status in this period to minimize the risk of perioperative complications. The physician should use these data to provide informed consent of the increased risk to patients planning to undergo TJAs with elevated malnutrition markers. Because this research is retrospective in nature, albumin should be studied prospectively in hypoalbuminemic and normoalbuminemic patients and their postoperative outcomes should be measured. Regarding transferrin and TLC, future research should help elucidate their predictive value and determine the value of preoperatively optimizing them and their effect in mitigating postoperative complications.
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Choi JT, Yoshida B, Jalali O, Hatch GF. Malnutrition in Orthopaedic Sports Medicine: A Review of the Current Literature. Sports Health 2020; 13:65-70. [PMID: 32639180 DOI: 10.1177/1941738120926168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
CONTEXT Malnutrition is well-studied in various aspects of the orthopaedic literature, most commonly in relation to arthroplasty, spine surgery, and trauma. However, the management of nutritional deficiencies is commonly overlooked among orthopaedic sports medicine providers. The purpose of this article is to analyze the available sports medicine literature to review the associations between malnutrition and the management of orthopaedic sports medicine patients from a treatment and performance standpoint. EVIDENCE ACQUISITION PubMed was searched for relevant articles published from 1979 to 2019. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Few studies exist on the implications of macronutrient deficiencies specific to orthopaedic sports medicine procedures. Interestingly, micronutrient disorders-namely, hypovitaminosis D and iron deficiency-have been well studied and may lead to worse postoperative outcomes, injury rates, and athletic performance. Nutritional supplementation to correct such deficiencies has been shown to mitigate these effects, though further study is required. CONCLUSION Nutritional deficiencies are highly prevalent in orthopaedic sports medicine patients, and practitioners should be aware of their potential effects on treatment and performance outcomes. Management of such deficiencies and their effect on surgical patients remain an area of potential future research. Future studies are warranted in order to explore the potential therapeutic role of nutritional supplementation to prevent complications after common orthopaedic sports medicine procedures, improve athletic performance, and reduce injury rates.
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Affiliation(s)
- Jihoon T Choi
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Brandon Yoshida
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Omid Jalali
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - George F Hatch
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Recent advances and controversies in surgical intervention of nontuberculous mycobacterial lung disease: A literature review. J Formos Med Assoc 2020; 119 Suppl 1:S76-S83. [DOI: 10.1016/j.jfma.2020.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 11/21/2022] Open
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22
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Serum albumin levels predict which patients are at increased risk for complications following surgical management of acute osteoporotic vertebral compression fractures. Spine J 2019; 19:1796-1802. [PMID: 31255789 DOI: 10.1016/j.spinee.2019.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/17/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Osteoporotic vertebral compression fractures (OVCF) account for a substantial portion of the US healthcare financial burden. With a growing elderly population, the number of fractures contributing to sagittal imbalance is expected to increase. For those patients undergoing surgery, preoperative markers, such as albumin, may help to predict the occurrence of postoperative complications. PURPOSE To evaluate the association between preoperative serum albumin levels and the incidence of postoperative complications, mortality, and 30-day readmissions following surgical intervention for OVCF. STUDY DESIGN Retrospective study. PATIENT SAMPLE Patient data were obtained from the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSIP) database between the years 2007 and 2014. OUTCOME MEASURES No outcome measures related to self-reporting, physiology, or functionality were evaluated in this study. Primary outcome measures analyzed included various postoperative complications, patient mortality, and 30-day readmission. METHODS A retrospective analysis of the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database between 2007 and 2014 was performed, identifying 1,979 patients who met inclusion criteria. Patients were subcategorized into three groups based on preoperative nutritional status as defined by albumin levels. Outcome measures for this study included minor postoperative complication(s), major postoperative complication(s), patient mortality, 30-day readmission due to any cause, 30-day readmission related to OVCF, and total length of hospital stay. Analysis of variance was used to evaluate for associations between continuous variables and preoperative albumin levels. Spearman's rank correlation coefficient, chi-square trend, and Kruskal-Wallis analyses were utilized, as appropriate, for categorical variables. A multivariate logistic regression analysis was then conducted to calculate odds ratios with corresponding p values and 95% confidence intervals. RESULTS Functional status showed a statistically significant decline when correlated with preoperative albumin levels. Sepsis, septic shock, pulmonary embolism, reintubation, prolonged intubation, and major complications in general are statistically more likely to occur in patients with hypoalbuminemia. Among minor complications evaluated in this study, only surgical site complications failed to demonstrate a statistical correlation with nutritional status. No statistically significant associations were identified between postoperative outcomes and age, sex, or BMI. CONCLUSIONS Preoperative albumin levels were statistically correlated to the likelihood of minor complications, major complications, or mortality.
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Lavery LA, Crisologo PA, Yavuz M. What is the most durable construct for a forefoot amputation, traditional transmetatarsal amputation or a medial ray sparing procedure? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S47. [PMID: 31032326 DOI: 10.21037/atm.2019.02.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Peter A Crisologo
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Metin Yavuz
- Department of Physical Therapy, UNT Health Science Center, Ft Worth, Texas, USA
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