Preoperative Malnutrition Negatively Correlates With Postoperative Wound Complications and Infection After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

Abstract

Background: Malnutrition continues to be prevalent in the general population. A variety of studies have correlated poor nutritional status with reduced perioperative outcomes. However, the correlation between serologic malnutrition and arthroplasty outcomes has not been systematically evaluated. The purpose of this study was to determine if serologic malnutrition has a correlation with postoperative wound infection, as well as other complications, after total joint arthroplasty.

Methods: A systematic review of the literature was performed to identify studies that reported on outcomes for patients who were malnourished and had undergone a total hip or knee arthroplasty.

Results: Twenty studies were included for review. Based on the quality of the evidence of the different studies, the balance between desirable/undesirable outcomes and the values of patients, there was a strong recommendation that preoperative serologic markers of malnutrition are significantly associated with inferior postoperative outcomes. All 20 studies analyzed albumin as a marker for malnutrition. Eleven (55%) studies used the total lymphocyte count, and 6 (30%) studies reported transferrin as a marker for malnutrition. Among 20 studies, 18 (90%) studies reported a correlation with at least one serological marker and poor postoperative outcomes. Finally, patients with an albumin level <3.5 dg/L were more likely to develop a postoperative wound complication (odds ratio: 2.176; 95% confidence interval: 1.916-2.471).

Conclusions: There is strong evidence that serologic malnutrition was associated with increased risk of poor postoperative outcome across all total joint replacement interventions.

Keywords: albumin; hip arthroplasty; knee arthroplasty; malnutrition; postoperative complications.