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J Arthroplasty. 2016 Jan;31(1):15-21. doi: 10.1016/j.arth.2015.08.028. Epub 2015 Aug 29.

Hypoalbuminemia Independently Predicts Surgical Site Infection, Pneumonia, Length of Stay, and Readmission After Total Joint Arthroplasty.

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Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
University of North Carolina School of Medicine, Chapel Hill, North Carolina.


This study investigates the association between preoperative hypoalbuminemia, a marker for malnutrition, and complications during the 30 days after total joint arthroplasty. Patients who underwent elective primary total hip and knee arthroplasty as part of the American College of Surgeons National Surgical Quality Improvement Program were identified. Outcomes were compared between patients with and without hypoalbuminemia (serum albumin concentration <3.5 g/dL) with adjustment for patient and procedural factors. A total of 49603 patients were included. In comparison to patients with normal albumin concentration, patients with hypoalbuminemia had a higher risk for surgical site infection, pneumonia, extended length of stay, and readmission. Future efforts should investigate methods of correcting nutritional deficiencies prior to total joint arthroplasty. If successful, such efforts could lead to improvements in short-term outcomes for patients.


hypoalbuminemia; malnutrition; periprosthetic joint infection; pneumonia; surgical site infection; total joint arthroplasty

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