Optimize Postop Nutrition for Improved Hip Surgery Results
In elderly patients undergoing hip fracture surgery, is serum albumin level associated with death, specific postoperative complications, length of stay, and readmission?
Those were the questions posed by researchers from Rush University Medical Center in Chicago and the University of North Carolina School of Medicine. Their study, “Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture,” was published in the December 20, 2017 edition of The Journal of Bone and Joint Surgery.
Craig Della Valle, M.D., chief of the Division of Adult Reconstructive Service at Rush, commented to OTW, “We have previously examined the link between hypoalbuminemia and complications following elective hip and knee arthroplasty and found that it was consistently associated with poor outcomes when examining important variables including the risk of infection, complications and economic indicators as well such as length of hospital stay.”
“Examining geriatric hip fractures was a natural progression. Clearly the most surprising link was the strong association between hypoalbuminemia and mortality. It has long been recognized that mortality is high after geriatric hip fractures and with a simple blood test done before surgery we seem to be able to identify those patients at highest risk.”
The authors wrote, “A retrospective cohort study of geriatric patients (≥65 years of age) undergoing a hip fracture surgical procedure as part of the American College of Surgeons National Surgical Quality Improvement Program was conducted. Outcomes were compared between patients with and without hypoalbuminemia…. There were 29,377 geriatric patients undergoing a hip fracture surgical procedure who met inclusion criteria; of these patients, 17,651 (60.1%) had serum albumin available for analysis.”
Dr. Della Valle told OTW, “I think as orthopedic surgeons we need to be thinking about our patients more ‘holistically’ and their nutritional status is one important factor to consider.”
“Based on these findings, surgeons may consider trying to optimize a patient’s nutrition in the perioperative period following surgical management. It would also seem important to consider the albumin status when risk stratifying for public reporting or payment purposes.”
Daniel Bohl, M.D., M.P.H. an orthopedic resident at Rush University and co-author on the research, told OTW, “The close association of albumin level with mortality risk was impressive. Albumin can be used to inform the prognosis prior to geriatric hip fracture surgery and guide nutritional intervention after geriatric hip fracture surgery.”
“The next step is prospective, randomized studies designed to guide nutritional interventions shortly following surgery.”
