Determination of Malnutrition Status and Risk Factors in Orthopedic Patients

Abstract

Objective: The aim of this study is to determine the malnutrition status and risk factors in orthopedic patients. Materials and Methods: The cross-sectional study was conducted between 05/2017 and 12/2018 in a university hospital in the west of Turkey Orthopedics and Traumatology Clinic with 123 patients. Research data were collected using the Patient Diagnosis and Clinical Form, Nutritional Risk Screening (NRS). Results: The average age of the patients is 65.72 ± 20.79. The average fasting time of patients who underwent surgery was 10.82 ± 3.20 hours before surgery and 11.01 ± 10.84 hours after surgery. It was found that 31.7% of the patients were under the risk of malnutrition and not all of them received nutritional support. The mean age of the patients with malnutrition risk was higher (t =-4.087, p=0.000). Patients with malnutrition risk had longer periods of fasting before surgery than those without risk (t=-3.019, p=0.000). Patients who had undergone surgery and had malnutrition risk had their first mobilization in a longer period after surgery (t=-4.113, p=0.000). A statistically significant difference was found between the patients' albumin values and NRS scores (t=5.751, p=0.000). A statistically significant difference was found between the participants' gender (X2=4.809 p=0.028), education level (X2=10.358, p=0.0016), presence of chronic disease (X2=5.890, p=0.015) and infection (X2=7.566.5, p =0.006) and their NRS scores. Conclusion: In our study, it was found that approximately one out of three patients was at risk of malnutrition. Our research results showed that other risk factors affecting the malnutrition risk of patients are age, gender, education level of the patients, presence of comorbid disease, low albumin level, preoperative fasting period and postoperative infection development. In addition, it was found that the first postoperative mobilization period of patients with malnutrition risk was later. Nutritional support approaches should be standardized with a professional team approach in line with current guidelines.

Keywords

• Malnutrition
• Nutritional Risk Screening
• Orthopedics ve Traumatology.

Ortopedi Hastalarının Malnütrisyon Durumları ve Risk Faktörlerinin Belirlenmesi

Abstract

Giriş ve Amaç: Bu çalışmanın amacı ortopedi hastalarının malnütrisyon durumlarının ve risk faktörlerinin belirlenmesidir. Gereç ve Yöntemler: Kesitsel tipteki çalışma 05/2017 -12/2018 tarihleri arasında XXX hastanesinde Ortopedi ve Travmatoloji Kliniğinde toplam 123 hasta ile gerçekleştirildi. Araştırma verileri, Hasta Tanılama ve Klinik Formu, Nutrisyonel Risk Taraması Ölçeği (Nutritional Risk Screening) kullanılarak toplanmıştır. Bulgular: Hastaların yaş ortalaması 65,72±20,79 dır. Cerrahi girişim geçiren hastaların aç kalma süre ortalamaları ameliyat öncesi 10,82±3,20 saat, ameliyat sonrası ise 11,01±10,84 saattir. Hastaların %31,7’sinin malnütriyon riski altında olduğu ve tamamının beslenme desteği almadığı saptandı. Malnütrisyon riski olan hastaların yaş ortalaması daha yüksekti (t=-4,087, p=0,000). Malnütriyon riski olan hastaların ameliyat öncesi aç kalma süreleri, riski olmayanlara göre daha uzundu (t=-3,019, p=0,000). Ameliyat olup malnütrisyon riski olan hastaların ameliyat sonrası ilk mobilizasyonları daha uzun sürede gerçekleşmişti (t=-4,113, p=0,000). Hastaların albumin değerleri ile NRS skorları arasında istatiksel olarak anlamlı bir fark saptandı (t=5,751, p=0,000). Katılımcıların cinsiyet (X2=4,809 p=0,028), eğitim düzeyleri (X2=10,358, p=0,0016), kronik hastalık varlığı (X2=5,890, p=0,015) ve enfeksiyonu durumu (X2=7,566, p=0,006) ile NRS skorları arasında istatiksel olarak anlamlı fark saptandı. Sonuç: Çalışmamızda yaklaşık üç hastadan birinin malnütriyon riski altında olduğu saptanmıştır. Araştırma sonuçları hastaların malnütrisyon riskini etkileyen diğer seçilmiş faktörlerin yaş, cinsiyet, hastaların eğitim düzeyi, komorbit hastalık varlığı, düşük albumin düzeyi, ameliyat öncesi açlık süresi ve ameliyat sonrası enfeksiyon gelişmesi olduğunu göstermiştir. Ayrıca malnütrisyon riski olan hastaların ameliyat sonrası ilk mobilizasyon sürelerinin daha geç olduğu saptanmıştır. Güncel rehberler doğrultusunda, profesyonel bir ekip yaklaşımı ile beslenme desteği yaklaşımları standart haline getirilmelidir.

Keywords

• beslenme
• beslenme risk değerlendirme
• ortopedi ve travmatoloji

References

1. Ihle, C, Freude, T, Bahrs, C, Zehendner, E, Braunsberger, J, Biesalski, H.K, et al., Malnutrition – An underestimated factor in the inpatient treatment of traumatology and orthopedic patients: A prospective evaluation of 1055 patients, Injury, 2017, 48(3), 628–36.
2. Bell, J.J, Pulle, R.C, Crouch, A.M, Kuys, S.S, Ferrier, R.L, Whitehouse S.L, Impact of malnutrition on 12-month mortality following acute hip fracture, ANZ Journal of Surgery, 2016, 86(3),157–61.
3. Kondrup, J, Ramussen, H.H, Hamberg, O, Stanga, Z, Camilo, M, Richardson, R, et al. Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trial, Clinical Nutrition, 2003, 22(3), 321–36.
4. Cederholm, T, Bosaeus, I, Barazzoni,, R, Bauer J, Van Gossum,, A, Klek S, et al, Diagnostic criteria for malnutrition - An ESPEN Consensus Statement, Clinical Nutrition, 2015, 34(3), 335–40.
5. Meijers, J.M.M, van Bokhorst-de van der Schueren, M.A.E, Schols, J.M.G.A, Soeters, P.B, Halfens, R.J.G, Defining malnutrition: Mission or mission impossible? Nutrition, 2010, 26(4), 432–40.
6. Geurden, B, Franck, E, Weyler, J, Ysebaert, D, The risk of malnutrition in community-living elderly on admission to hospital for major surgery, Acta Chirurgica Belgica, 2015, 115(5), 341–7.
7. Wang, N, Dong, Y.L, Huo, T, Shao, Y, Xing, W, Li, S, Nutritional risk, malnutrition and nutritional support among hospitalized patients in orthopedics/spinal surgery of a Hohhot teaching hospital, Asia Pacific Journal of Clinical Nutrition, 2016, 25(2), 273–82.
8. Deren, M.E, Huleatt, J, Winkler, M.F, Rubin, L.E, Salzler, M.J, Behrens, S.B, Assessment and Treatment of Malnutrition in Orthopaedic Surgery. JBJS Reviews, 2014, 2(9), 1.

9. Thomas, M.N, Kufeldt, J, Kisser, U, Hornung, H.M, Hoffmann, J, Andraschko, M, et al., Effects of malnutrition on complication rates, length of hospital stay, and revenue in elective surgical patients in the G-DRG-system, Nutrition, 2016, 32(2), 249–54.
10. Felder ,S, Lechtenboehmer, C, Bally, M, Fehr, R, Deiss, M, Faessler, L, et al., Association of nutritional risk and adverse medical outcomes across different medical inpatient populations, Nutrition, 2015, 31(11–12), 1385–93.
11. Khalatbari-Soltani, S, Marques-Vidal, P, The economic cost of hospital malnutrition in Europe; a narrative review, Clinical Nutrition ESPEN, 2015, 10(3), 89–94.
12. Koren-Hakim, T, Weiss, A, Hershkovitz, A, Otzrateni, I, Anbar, R, Gross Nevo, R.F, et al., Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients, Clinical Nutrition, 2016, 35(5), 1053–8.
13. Bohl, D.D, Shen, M.R, Hannon, C.P, Fillingham, Y.A, Darrith, B, Valle, C.J.D, Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture, The Journal of Bone and Joint Surgery, 2017, 99(24), 2110–8.
14. Ferhatoğlu, S.Y, Dönmez, N.F, The effect of nutritional status on length of hospital stay in adult patients undergoing elective orthopedic surgery: a prospective analysis, Haseki Tıp Bülteni, 2020, 58, 228–33.
15. Ihle, C, Weiß, C, Blumenstock,, G, Stöckle, U, Ochs, B.G, Bahrs, C, et al., Interview based malnutrition assessment can predict adverse events within 6 months after primary and revision arthroplasty - A prospective observational study of 351 patients, BMC Musculoskelet Disorders, 2018, 19(1), 1–11.
16. Black, C.S, Goltz, D.E, Ryan, S.P, Fletcher, A.N, Wellman, S.S, Bolognesi, M.P, et al., The Role of Malnutrition in Ninety-Day Outcomes After Total Joint Arthroplasty, Joint Arthroplasty, 2019, 34(11), 2594–600.
17. Weimann, A, Braga, M, Carli, F, Higashiguchi, T, Hübner, M, Klek, S, et al., ESPEN guideline: Clinical nutrition in surgery, Clinical Nutrition, 2017, 36(3), 623–50.
18. Maurer, E, Wallmeier, V, Reumann, M.K, Ehnert, S, Ihle, C, Schreiner. A.J, et al., Risk of malnutrition in orthopedic trauma patients with surgical site infections is associated with increased morbidity and mortality – a 3-year follow-up study, Injury, 2020, 51(10), 2219–29.
19. Kruizenga, H.M, Van Tulder, M.W, Seidell, J.C, Thijs, A, Ader, H.J, Van Bokhorst-de van der Schueren, M.A, Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients, The American Journal of Clinical Nutrition, 2005, 82(5), 1082–9.
20. Kaiser, M.J, Bauer, J.M, Rämsch, C, Uter, W, Guigoz, Y, Cederholm, T, et al., Frequency of malnutrition in older adults: A multinational perspective using the mini nutritional assessment, Journal of the American Geriatrics Society, 2010, 58(9), 1734–8.
21. Kehlet, H, Memtsoudis, S.G., ERAS guidelines for hip and knee replacement–need for reanalysis of evidence and recommendations?, Acta Orthopaedica et Traumatologica Turcica, 2020, 91(3), 243–5.
22. Dominguez, R.J, Burden of malnutrition in a tertiary care hospital in baguio city, SAGE Open, 2013, 3(3), 1-7.
23. Prasad, N, Gupta, A, Sinha, A, Sharma, R.K, Saxena, A, Kaul, A, et al., Confounding effect of comorbidities and malnutrition on survival of peritoneal dialysis patients, Journal of Renal Nutrition, 2010, 20(6), 384–91.
24. Arslan, M, Arslan Keskin, E, Koç, E, Sözmen, M, Kaplan, Y, Altmış beş yaş ve üzeri kişilerde kırılganlık ile ilaç kullanımı ve polifarmasi arasındaki ilişki, Haseki Tıp Bülteni, 2020, 58, 33–41.
25. Elkin, N, Yaşlılarda Polifarmasi ve akılcı ilaç kullanımına aile hekimliği yaklaşımı, IGUSABDER, 2020, 11, 279–90.
26. Herr, M, Robine, J.M, Pinot, J, Arvieu, J.J, Ankri, J, Polypharmacy and frailty: Prevalence, relationship, and impact on mortality in a French sample of 2350 old people, Pharmacoepidemiol Drug Safety, 2015, 24(6), 637–46.
27. Kubat Bakir, G, Akin, S, Yaşlılıkta kronik hastalıkların yönetimi ile ilişkili faktörler, Sağlık ve Toplum, 2019, 2, 17-25.
28. Türten Kaymaz, T, Akdemi̇r, N, Diyabetli Bireylerde Hastalığa Psikososyal Uyum, Psikiyatr Hemşireliği Dergisi, 2016,7(2),61–7.
29. Baykal, A, Kapucu, S, Tip 2 diyabetes mellituslu hastaların tedavilerine uyumlarının değerlendirilmesi, Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 2015,2(2),44–58.
30. Neyens, J, Halfens, R, Spreeuwenberg, M, Meijers, J, Luiking, Y, Verlaan, G, et al, Malnutrition is associated with an increased risk of falls and impaired activity in elderly patients in Dutch residential long-term care (LTC): A cross-sectional study, Archives of Gerontology and Geriatrics, 2013,56(1),265–9.
31. Tominaga, H, Oku, M, Arishima, Y, Ikeda, T, Ishidou ,Y, Nagano, S, et al., Association between bone mineral density, muscle volume, walking ability, and geriatric nutritional risk index in hemodialysis patients, Asia Pacific Journal of Clinical Nutrition, 2018, 27(5), 1062–6.
32. Bozic, K.J, Lau, E, Kurtz, S, Ong, K, Rubash, H, Vail, T.P, et al. Patient-Related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in medicare patients, The Journal of Bone and Joint Surgery, 2012, 94(9), 794–800.
33. Kankiliç, R, Tuna, A, Transüretral rezeksiyon-prostat (tur-p) ameliyatlarında eras protokolü ile ameliyat öncesi ve sonrası yapılması gereken beslenme, ağrı ve erken mobilizasyon uygulamalarının karşılaştırılması, Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi, 2019, 14(2), 69-72.
34. Gök, F, Van Giersbergen, M, Ameliyat öncesi aç kalma: Sistematik derleme Preoperative fasting: A systematic review, Pamukkale Tıp Dergisi, 2018, 11(2), 183–94.
35. Shpata, V, Prendushi, X, Kreka, M, Kola, I, Kurti, F, Ohri, I, Malnutrition at the time of surgery affects negatively the clinical outcome of critically ill patients with gastrointestinal cancer, Medical Archieves, 2014, 68(4), 263–7.
36. Mignini, E.V, Scarpellini, E, Rinninella, E, Lattanzi, E, Valeri, M.V, Clementi, N, et al., Impact of patients nutritional status on major surgery outcome, European Review for Medical and Pharmacological Sciences, 2018, 22(11), 3524–33.
37. Guo, J.J, Yang, H, Qian, H, Huang, L, Guo, Z, Tang, T, The Effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly, Journal of Surgical Research, 2010, 159(1), 503–8. 38. Lambert, C, Nüssler, A, Biesalski, H.K, Freude, T, Bahrs, C, Ochs, G, et al., Age-dependent risk factors for malnutrition in traumatology and orthopedic patients, Nutrition, 2017, 37, 60–7.