Abstract
Background
Obesity is frequently associated with complications after total hip arthroplasty (THA)
and is often concomitant with malnutrition. The purpose of this study was to investigate
the independent morbidity risk of malnutrition relative to obesity.
Methods
The National Surgical Quality Improvement Program from 2005 to 2013 was queried for
elective primary THA cases. Malnutrition was defined as albumin <3.5 g/dL. Propensity
scores for having preoperative albumin data were determined from demographics, body
mass index, and overall comorbidity burden. Patients were classified as nonobese (body
mass index 18.5-29.9), obese I (30-34.9), obese II (35-39.9), or obese III (≥40).
Complications were compared across nutritional and obesity classes. Multivariable
propensity-adjusted logistic regressions were used to examine associations between
obesity and malnutrition with 30-day outcomes.
Results
A total of 40,653 THA cases were identified, of which 20,210 (49.7%) had preoperative
albumin measurements. Propensity score adjustment successfully reduced potential selection
bias, with P > .05 for differences between those with and without albumin data. Malnutrition incidence
increased from 2.8% in obese I to 5.7% in obese III patients. With multivariable propensity-adjusted
logistic regression, malnutrition was a more robust predictor than any obesity class
for any postoperative complication(s) (odds ratio [OR] 1.61, 95% confidence interval
[CI] 1.25-2.08), major complications (OR 1.63, 95% CI 1.21-2.19), respiratory complications
(OR 2.35, 95% CI 1.27-4.37), blood transfusions (OR 1.71, 95% CI 1.44-2.03), and extended
length of stay (OR 1.35, 95% CI 1.14-1.59).
Conclusion
Malnutrition incidence increased significantly from obese I to obese III patients
and was a stronger and more consistent predictor than obesity of complications after
THA.
Keywords
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Article info
Publication history
Published online: May 05, 2016
Accepted:
April 26,
2016
Received in revised form:
April 15,
2016
Received:
February 28,
2016
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.04.032.
Identification
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© 2016 Elsevier Inc. All rights reserved.
