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. 2025 May 23;35(1):213.
doi: 10.1007/s00590-025-04317-1.

Increasingly severe malnutrition according to the geriatric nutritional risk index is associated with a greater risk of postoperative adverse events

Steven H Liu  1 , Brandon Lung  2 , Jane Burgan  3 , Rachel A Loyst  3 , Rebecca Liu  4 , Allen Bramian  3 , James J Nicholson  3 , Russell N Stitzlein  2
Affiliations

Increasingly severe malnutrition according to the geriatric nutritional risk index is associated with a greater risk of postoperative adverse events

Steven H Liu et al. Eur J Orthop Surg Traumatol. .

Abstract

Background: 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).

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Complications; Geriatric; Geriatric nutritional risk index; Malnutrition; Revision total knee arthroplasty.

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Conflict of interest statement

Declarations. Conflicts of interest: The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Case selection schematic. rTKA, Revision total knee arthroplasty; NSQIP, National surgical quality improvement program; ASA, American Society of Anesthesiologists
See this image and copyright information in PMC

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