Being malnourished is not good for surgery

Pennsylvania: Malnourished patients are more likely to have complications following total knee or hip replacement surgeries than morbidly obese patients,according to new research. When compared to patients with normal nutritional status, malnourished patients were nearly 20 percent more likely to have a postoperative complication, 13 percent more likely to be readmitted within 90 days of discharge, 12 percent more likely to have an ICU admission following surgery, and five percent more likely to require a return to the operating room.

“These findings can lead to the development of clear guidelines to identify which patients need remediation before undergoing total knee or hip replacement,” said lead investigator P. Maxwell Courtney, MD, a fourth-year orthopaedic surgery resident at the Perelman School of Medicine at the University of Pennsylvania. “While it would be beneficial for morbidly obese patients to lose weight for better overall health, our findings indicate that doing so is not necessarily indicative of a post-op complication.”
For the purposes of the study, malnourished patients were defined as having a pre-operative serum albumin level, a marker for adequate nutrition, of < 3.5 mg/dL. Morbidly obese patients were characterized by a pre-operative body mass index greater than 40 mg/kg2. Malnourishment so defined is independent of body weight. In fact, because of the greater volume of “empty calories” consumed, morbidly obese patients were more likely to be malnourished than non-morbidly-obese patients.
Among patients with normal nutritional status, morbidly obese patients had no statistically significant difference in complication rates than non-morbidly-obese patients. Malnourished morbidly obese patients also had no statistically significant difference in complication rates than malnourished non-morbidly-obese patients.
“Although our study did not examine whether correcting malnutrition prior to surgery would improve outcomes, it seems prudent to work with dieticians to improve the nutritional levels of patients who are malnourished, whether in the form of better food selection, nutritional supplements, or both,” said the study’s senior author Charles L. Nelson, MD, chief of the Joint Replacement Service in the department of Orthopaedic Surgery, noting that further research on such patients is warranted.
Other Penn co-authors are Joshua C. Rozell, MD, Christopher M. Melnic, MD, and Neil P. Sheth MD.

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