Eric H. Tischler, Jake R. McDermott, Shivasuryan Vummidi, Samer A. Mahmoud, Jonathan M. Gross, Aden N. Malik, Nishant Suneja
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This study evaluates the role preoperative albumin as an independent risk factor for mortality and increased length of stay (LOS) among distal femur fracture (DFF) patients.</p><h3>Methods</h3><p>Between 2010 and 2019, the National Surgical Quality Improvement Program (NSQIP) identified isolated closed distal femur fractures preoperative albumin levels using International Classification of Diseases 9th and 10th revisions (ICD9/ICD10) codes [S72.4*; 821.2*]. Albumin was categorized as both continuous and categorical variables: marked hypoalbuminemia (< 2.5 g/dL), mild hypoalbuminemia (2.5–3.5 g/dL), normal albuminemia (3.5–4.5 g/dL) or hyperalbuminemia (> 4.5 g/dL). Primary outcomes included in-hospital mortality and LOS.</p><h3>Results</h3><p>The incidence rate of hypoalbuminemia was 54.6% (419/767). Multivariable logistic regression analysis demonstrated that when compared to patients with baseline marked hypoalbuminemia, patients with mild hypoalbuminemia and normal serum albumin reported a respective 82% (OR 0.18, 95% CI [0.04, 0.71], <i>p</i> = 0.014) and 80% (OR: 0.20, 95% CI [0.05, 0.89], <i>p</i> = 0.034) decreased odds of in-hospital mortality. Similarly, a 53.7% (OR 0.46, 95% CI [0.23, 0.94], <i>p</i> = 0.033), 71.1% (OR 0.29, 95% CI [0.14, 0.60], <i>p</i> = 0.001), and 82.8% (OR 0.17, 95% [0.04, 0.75], <i>p</i> = 0.020) decreased odds of exceeding mean LOS was observed among mild hypoalbuminemic, normal, and hyperalbuminemic patients compared to patients with baseline marked hypoalbuminemia.</p><h3>Conclusion</h3><p>Preoperative hypoalbuminemia is an independent risk factor for increased LOS and mortality among DFFs, controlling for confounding factors. Prospective investigation of albumin risk stratification is warranted to differentiate contributable effects of chronic malnutrition and traumatic inflammatory albumin downregulation among geriatric trauma patients.</p><h3>Level of evidence</h3><p>Prognostic Level III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Is it time to Reassess The Role of Preoperative HypoalbuminemiaAmong Geriatric Distal Femur Fracture Patients?\",\"authors\":\"Eric H. Tischler, Jake R. McDermott, Shivasuryan Vummidi, Samer A. Mahmoud, Jonathan M. Gross, Aden N. 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Albumin was categorized as both continuous and categorical variables: marked hypoalbuminemia (< 2.5 g/dL), mild hypoalbuminemia (2.5–3.5 g/dL), normal albuminemia (3.5–4.5 g/dL) or hyperalbuminemia (> 4.5 g/dL). Primary outcomes included in-hospital mortality and LOS.</p><h3>Results</h3><p>The incidence rate of hypoalbuminemia was 54.6% (419/767). Multivariable logistic regression analysis demonstrated that when compared to patients with baseline marked hypoalbuminemia, patients with mild hypoalbuminemia and normal serum albumin reported a respective 82% (OR 0.18, 95% CI [0.04, 0.71], <i>p</i> = 0.014) and 80% (OR: 0.20, 95% CI [0.05, 0.89], <i>p</i> = 0.034) decreased odds of in-hospital mortality. 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引用次数: 0
摘要
背景：低白蛋白血症被笼统地定义为白蛋白3.5 g/dL，在骨科和非骨科手术中，低白蛋白血症常被用作与术后并发症和死亡率相关的阈值。白蛋白水平受多种因素的影响，包括肝功能、营养不良和炎症。本研究评估了术前白蛋白作为股骨远端骨折（DFF）患者死亡率和住院时间（LOS）增加的独立危险因素的作用。方法2010年至2019年，国家外科质量改进计划（NSQIP）使用国际疾病分类第9版和第10版（ICD9/ICD10）代码确定孤立性闭合性股骨远端骨折术前白蛋白水平[S72.4*；821.2 *]。白蛋白被分类为连续变量和分类变量：显著低白蛋白血症（2.5 g/dL）、轻度低白蛋白血症（2.5 - 3.5 g/dL）、正常白蛋白血症（3.5-4.5 g/dL）或高白蛋白血症（4.5 g/dL）。主要结局包括住院死亡率和LOS。结果低白蛋白血症发生率为54.6%（419/767）。多变量logistic回归分析显示，与基线明显低白蛋白血症患者相比，轻度低白蛋白血症患者和血清白蛋白正常患者的住院死亡率分别降低82% （OR 0.18, 95% CI [0.04, 0.71], p = 0.014）和80% （OR: 0.20, 95% CI [0.05, 0.89], p = 0.034）。同样，与基线标记为低白蛋白血症的患者相比，轻度低白蛋白血症、正常和高白蛋白血症患者超过平均LOS的几率分别降低53.7% （OR 0.46, 95% CI [0.23, 0.94], p = 0.033）、71.1% （OR 0.29, 95% CI [0.14, 0.60], p = 0.001）和82.8% （OR 0.17, 95% [0.04, 0.75], p = 0.020）。结论术前低白蛋白血症是dff患者LOS和死亡率升高的独立危险因素，控制了混杂因素。白蛋白风险分层的前瞻性研究有必要区分慢性营养不良和创伤性炎症性白蛋白下调对老年创伤患者的影响。证据水平：预后III级。
Is it time to Reassess The Role of Preoperative HypoalbuminemiaAmong Geriatric Distal Femur Fracture Patients?
Background
Hypoalbuminemia, blanketly defined as Albumin < 3.5 g/dL, is often utilized as a threshold associated with postoperative complications and mortality among orthopedic and non-orthopedic surgical procedures. Albumin level is influenced by a myriad of factors including liver function, malnutrition, and inflammation. This study evaluates the role preoperative albumin as an independent risk factor for mortality and increased length of stay (LOS) among distal femur fracture (DFF) patients.
Methods
Between 2010 and 2019, the National Surgical Quality Improvement Program (NSQIP) identified isolated closed distal femur fractures preoperative albumin levels using International Classification of Diseases 9th and 10th revisions (ICD9/ICD10) codes [S72.4*; 821.2*]. Albumin was categorized as both continuous and categorical variables: marked hypoalbuminemia (< 2.5 g/dL), mild hypoalbuminemia (2.5–3.5 g/dL), normal albuminemia (3.5–4.5 g/dL) or hyperalbuminemia (> 4.5 g/dL). Primary outcomes included in-hospital mortality and LOS.
Results
The incidence rate of hypoalbuminemia was 54.6% (419/767). Multivariable logistic regression analysis demonstrated that when compared to patients with baseline marked hypoalbuminemia, patients with mild hypoalbuminemia and normal serum albumin reported a respective 82% (OR 0.18, 95% CI [0.04, 0.71], p = 0.014) and 80% (OR: 0.20, 95% CI [0.05, 0.89], p = 0.034) decreased odds of in-hospital mortality. Similarly, a 53.7% (OR 0.46, 95% CI [0.23, 0.94], p = 0.033), 71.1% (OR 0.29, 95% CI [0.14, 0.60], p = 0.001), and 82.8% (OR 0.17, 95% [0.04, 0.75], p = 0.020) decreased odds of exceeding mean LOS was observed among mild hypoalbuminemic, normal, and hyperalbuminemic patients compared to patients with baseline marked hypoalbuminemia.
Conclusion
Preoperative hypoalbuminemia is an independent risk factor for increased LOS and mortality among DFFs, controlling for confounding factors. Prospective investigation of albumin risk stratification is warranted to differentiate contributable effects of chronic malnutrition and traumatic inflammatory albumin downregulation among geriatric trauma patients.
期刊介绍：
"Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance.
"Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).
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