Hypoalbuminemia Leads to An Increased Risk Of Mortality And Re-Operation Within 3-Months In Patients 75< Years Of Age After Surgery For Hip Fractures

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Erhan Şükür
Alauddin Kochai
Ihsan OZ
Zafer Sen


Keywords: hip fractures, hypoalbuminemia, frail elderly


Background: The focus of this study is to ascertain a baseline nutritional level of adults 75 years old who are hospitalized for hip fracture surgery, and to assess the effects on the mortality rates and post-operative complications that require re-operation within 3 months of the initial surgery. Material and Methods: A total of 240 patients having surgery for fractured hips during 2017-2019 were identified. Patients' characteristics, including pre-operative laboratory findings, complications and reoperation rates were assessed. Multivariate logistic regression analysis was used to establish the effect of hypoalbuminemia and total lymphocyte count on the rates of 3-month post-operative complications, re-operation and mortality. Results: Among patients studied, 153 had hypoalbuminemia (albumin levels <3.5 g/dL), and 87 showed normal albumin levels (albumin levels ³3.5 g/dL). Patients in the hypoalbuminemia group were likely to be functionally dependent (p = 0.002) and had higher Charlson comorbidity scores (p = 0.006) than their counterparts. The American Society of Anesthesiologists score and albumin levels were significant predictors of re-operation (p = 0.013, p = 0.039). The increase in age by 1 year, albumin level <3.5 g/dL, and lymphocyte count <1500 cells/mm3 were associated with increased mortality rates (p = 0.012, p = 0.004, p = 0.002). Conclusion:  Malnutrition is high in patients with hip fractures. In this study, hypoalbuminemia and lymphocyte count (<1500 cells/mm3) were directly associated with post-operative mortality rates and complications that required re-operation within 3 months of initial surgery.



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1- Dhanwal DK, Dennison EM, Harvey NC, et al. Epidemiology of hip fracture: worldwide geographic variation. Indian J Orthop. 2011;45:15–22.
2- Rohde G, Haugeberg G, Mengshoel AM, Moum T, Wahl AK. Two-year changes in quality of life in elderly patients with low-energy hip fractures. A case control study. BMC Musculoskelet Disord 2010; 11: 226.
3- Shyu YI, Chen MC, Liang J, Wu CC, Su JY. Predictors of functional recovery for hip fractured elders during 12 months following hospital discharge: a prospective study on a Taiwanese sample. Osteoporos Int 2004;15:475-82.
4- Chung AS, Hustedt JW, Walker R, Jones C, Lowe J, Russell GV. Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery. J Orthop Trauma. 2018 Apr;32(4):155-160. doi: 10.1097/BOT.0000000000001081. PMID: 29558371
5- Wyers CE, Reijven PLM, Breedveld-Peters JJL, Denissen KFM, Schotanus MGM, van
Dongen MCJM, Eussen SJPM, Heyligers IC, van den Brandt PA, Willems PC, van Helden S, Dagnelie PC. Efficacy of Nutritional Intervention in Elderly After Hip Fracture: A Multicenter Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci. 2018 Sep 11;73(10):1429-1437. doi: 10.1093/gerona/gly030. PMID: 30204859
6- Díaz de Bustamante M, Alarcón T, Menéndez-Colino R, Ramírez-Martín R, Otero Á, González-Montalvo JI. Prevalence of malnutrition in a cohort of 509 patients with acute hip fracture: the importance of a comprehensive assessment. Eur J Clin Nutr. 2018 Jan;72(1):77-81. doi: 10.1038/ejcn.2017.72. Epub 2017 May 17. PMID: 28513623
7- Pedersen PU. Nutritional care: the effectiveness of actively involving older patients. J Clin Nurs. 2005 Feb;14(2):247-55. doi: 10.1111/j.1365-2702.2004.00874.x. PMID: 15669934
8- Deren, Matthew E; Huleatt, Joel; Winkler, Marion F; Rubin, Lee E; Salzler, Matthew J; Behrens, Steve B. Assessment and Treatment of Malnutrition in Orthopaedic Surgery. JBJS Reviews: September 02, 2014 - Volume 2 - Issue 9 - e1doi: 10.2106/JBJS.RVW.M.00125
9- Bell JJ, Pulle RC, Crouch AM, et al. Impact of malnutrition on 12-month mortality following acute hip fracture. ANZ J Surg 2016; 86: 157–161.
10- Newman JM, Sodhi N, Khlopas A, Piuzzi NS, Yakubek GA, Sultan AA, Klika AK, Higuera CA, Mont MA. Malnutrition increases the 30-day complication and reoperation rates in hip fracture patients treated with total hip arthroplasty. Hip Int. 2020 Sep;30(5):635-640. doi: 10.1177/1120700019862977. Epub 2019 Jul 15. PMID: 31304789
11- Li S, Zhang J, Zheng H, Wang X, Liu Z, Sun T. Prognostic Role of Serum Albumin, Total Lymphocyte Count, and Mini Nutritional Assessment on Outcomes After Geriatric Hip Fracture Surgery: A Meta-Analysis and Systematic Review. J Arthroplasty. 2019 Jun;34(6):1287-1296. doi: 10.1016/j.arth.2019.02.003. Epub 2019 Feb 11. PMID: 30852065
12- Charlson ME, Charlson RE, Peterson JC, et al. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol 2008; 61:1234–1240.
13- Cross MB, Yi PH, Thomas CF, et al. Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg. 2014;22:193–199.
14- Bell JJ, Bauer JD, Capra S, Pulle RC. Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients: a diagnostic accuracy study. Eur J Clin Nutr 2014;68:358-62.
15- White JV, Guenter P, Jensen G, Malone A, Schofield M, Academy Malnutrition Work Group, et al. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr 2012;36:275-83.
16- Koval KJ, Maurer SG, Su ET, Aharonoff GB, Zuckerman JD. The effects of nutritional status on outcome after hip fracture. J Orthop Trauma 1999;13:164-9.
17- Bohl DD, Shen MR, Hannon CP, Fillingham YA, Darrith B, Della Valle CJ. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. J Bone Joint Surg Am. 2017 Dec 20;99(24):2110-2118. doi: 10.2106/JBJS.16.01620. PMID: 29257017
18- Miu KYD, Lam PS. Effects of Nutritional Status on 6-Month Outcome of Hip Fractures in Elderly Patients. Ann Rehabil Med. 2017 Dec;41(6):1005-1012. doi: 10.5535/arm.2017.41.6.1005. Epub 2017 Dec 28. PMID: 29354577
19- Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med 2002;18:737e57.
20- Zekry D, Herrmann FR, Grandjean R, Meynet MP, Michel JP, Gold G, et al. Demented versus non-demented very old inpatients: the same comorbidities but poorer functional and nutritional status. Age Ageing 2008;37:83e9.
21- Aaldriks AA, Giltay EJ, le Cessie S, van der Geest LG, Portielje JE, Tanis BC, et al. Prognostic value of geriatric assessment in older patients with advanced breast cancer receiving chemotherapy. Breast (Edinburgh, Scotland). 2013;22(5):753-60.
22- Gumieiro DN, Rafacho BP, Goncalves AF, Tanni SE, Azevedo PS, Sakane DT, et al. Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture. The British journal of nutrition. 2013;109(9):1657-61.
23- Guo JJ, Yang H, Qian H, Huang L, Guo Z, Tang T. The effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly. The Journal of surgical research. 2010;159(1):503-8.
24- Lee HP, Chang YY, Jean YH, Wang HC. Importance of serum albumin level in the preoperative tests conducted in elderly patients with hip fracture. Injury. 2009;40(7):756-9.
25- Nicholson JA, Dowrick AS, Liew SM. Nutritional status and short-term outcome of hip arthroplasty. Journal of orthopaedic surgery (Hong Kong). 2012;20(3):331-5.

26- Peeters CM, Visser E, Van de Ree CL, Gosens T, Den Oudsten BL, De Vries J. Quality of life after hip fracture in the elderly: A systematic literature review. Injury. 2016 Jul;47(7):1369-82. doi: 10.1016/j.injury.2016.04.018. Epub 2016 Apr 23. PMID: 27178770
27- Lavernia CJ, Sierra RJ, Baerga L. Nutritional parameters and short term outcome in arthroplasty. Journal of the American College of Nutrition. 1999;18(3):274-8.
28- Miyanishi K, Jingushi S, Torisu T. Mortality after hip fracture in Japan: the role of nutritional status. Journal of orthopaedic surgery (Hong Kong). 2010;18(3):265-70.
29- Hoekstra JC, Goosen JHM, de Wolf GS, et al. Effectiveness of multidisciplinary nutritional care on nutritional intake, nutritional status and quality of life in patients with hip fractures: a controlled prospective cohort study. Clin Nutr Edinb Scotl. 2011;30:455–461.
30- Lumbers M, New SA, Gibson S, et al. Nutritional status in elderly female hip fracture patients: comparison with an age-matched home living group attending day centres. Br J Nutr. 2001;85:733–740.
31- Miyanishi K, Jingushi S, Torisu T. Mortality after hip fracture in Japan: the role of nutritional status. J Orthop Surg (Hong Kong). 2010;18:265–270.
32- O'Daly BJ, Walsh JC, Quinlan JF, et al. Serum albumin and total lymphocyte count as predictors of outcome in hip fractures. Clin Nutr 2010; 29: 89–93.
33- Cross MB, Yi PH, Thomas CF, et al. Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg 2014; 22: 193–199.