Journal CME, December 2021: Preoperative malnutrition is a risk factor for delayed recovery of mobilization after total hip arthroplasty-Preoperative malnutrition

Preoperative malnutrition - article.pdf

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This study, conducted by Yuta Nanri and colleagues, examines the impact of preoperative nutritional status on postoperative mobility after total hip arthroplasty (THA). Using a retrospective cohort design, 503 patients who underwent unilateral primary THA between 2015 and 2019 at a single hospital were included. The study found that 18.9% of these patients were classified as malnourished based on the Controlling Nutritional Status (CONUT) score, which evaluates serum albumin levels, total lymphocyte count, and total cholesterol levels.<br /><br />Results indicated that patients with preoperative malnutrition experienced a significant delay in postoperative mobilization, typically taking an extra day to start walking independently compared to those with normal nutritional status (6 vs. 5 days, p=0.006). Kaplan-Meier analysis supported these findings, showing a significant delay in mobilization for malnourished patients (p=0.001). Multivariate Cox proportional hazards models revealed that preoperative malnutrition was a significant predictor of delayed mobilization even after adjusting for age, gender, BMI, muscle strength, and comorbidities, with hazard ratios ranging from 0.70 to 0.74.<br /><br />Additionally, the study found that length of hospital stay (LOS) was significantly longer for malnourished patients (13 vs. 12 days, p=0.016). Multiple linear regression analysis demonstrated that preoperative malnutrition was a significant predictor of prolonged LOS. However, nutritional status did not significantly affect the discharge disposition—whether patients were sent home or to rehabilitation facilities; rather, preoperative quadriceps strength emerged as a significant predictor of discharge to rehabilitation.<br /><br />The findings suggest that malnutrition, as assessed by the CONUT score, is an important risk factor for delayed recovery of mobilization and prolonged hospital stays in THA patients. The study emphasizes the importance of assessing and possibly improving nutritional status preoperatively to enhance recovery outcomes in these patients. Further research is suggested to explore whether improving preoperative nutritional status can positively impact postoperative recovery.

Keywords

preoperative nutritional status

postoperative mobility

total hip arthroplasty

THA

malnutrition

CONUT score

hospital stay

recovery outcomes

nutritional assessment

retrospective cohort