Effects of preoperative nutrition status on postoperative complications and length of hospital stay in orthopedic surgery patients

Öz

Aim: This study was conducted to determine the relationship between malnutrition status, determined by using hypoalbunemia and NRS-2002, and various factors (socio-demographic, BMI) and clinical outcomes (length of hospital stay and postoperative complication development) during preoperative period in orthopedic surgery patients. Method: The study that designed in a descriptive-correlational model, was performed at a university hospital Health Research and Application Center between June and December 2019. Data were collected by face-to-face interview method using a questionnaire and Nutritional Risk Screening-2002 by researchers. Albumin levels obtained from patient files. Descriptive statistics and Chi-Square analysis were used to evaluate the data. Results: The prevalence of malnutrition risk in orthopedic surgical patients was 35.10% and 43.90% according to NRS 2002 score and the albumin level, respectively. There were statistically significant differences between the risk of malnutrition and chronic disease (p<0.001), re-hospitalization (p=0.012), postoperative length of hospital stay (p=0.001) and age (p<0.001) according to NRS 2002. There were statistically significant differences between preoperative (p=0.008) and postoperative length of hospital stay (p<0.001) according to albumin level. According to NRS 2002 and albumin level, it was found that the incidence of postoperative complications increased in patients with malnutrition risk (p<0.001 for each). Conclusion: In this study, the prevalence of malnutrition was found high in orthopedic surgery patients. In the preoperative period, malnutrition risk associated with age and the presence of chronic diseases. The length of hospital stay and post-operative complications increased in patients with malnutrition risk.

Anahtar Kelimeler

• Malnutrition
• orthopedics surgery
• postoperative complication
• NRS-2002
• length of hospital stay

Ortopedik cerrahi hastalarında preoperatif beslenme durumunun postoperatif komplikasyonlar ve hastanede kalış süresine etkisi

Öz

Amaç: Bu çalışma, ortopedik cerrahi hastalarında preoperatif dönemde hipoalbunemi ve NRS-2002 kullanılarak belirlenen malnutrisyon durumu ile çeşitli faktörler (sosyo-demografik, BKİ) ve klinik sonuçlar (hastanede kalış süresi ve postoperatif komplikasyon gelişme durumu) arasındaki ilişkiyi belirlemek amacıyla yapılmıştır. Yöntem: Tanımlayıcı-ilişki arayıcı nitelikte tasarlanan araştırma, Haziran- Aralık 2019 tarihleri arasında bir üniversitenin Sağlık Araştırma ve Uygulama Merkezinde yürütülmüştür. Veriler, araştırmacılar tarafından anket formu ve Nütrisyonel Risk Taraması-2002 kullanılarak yüz yüze görüşme yöntemiyle toplanmıştır. Albümin seviyelerine hasta dosyalarından erişilmiştir. Verilerin değerlendirilmesinde tanımlayıcı istatistikler ve Ki-Kare analizi kullanılmıştır. Bulgular: Ortopedik cerrahi hastalarının malnutrisyon risk prevalansı NRS 2002 puanına göre %35.10’unda, albümin düzeyine göre %43.90 bulunmuştur. Hastalarda NRS 2002’ ye göre malnutrisyon riski olma durumu ile kronik hastalık (p<0.001), hastaneye tekrar yatma (p=0.012), ameliyat sonrası yatış süresi (p=0.001) ve yaş ortalaması (p<0.001) arasında istatistiksel olarak anlamlı bir fark varken; albümin düzeyine göre ameliyat öncesi (p=0,008) ve ameliyat sonrası (p<0.001) yatış süresi arasında anlamlılık vardı. NRS 2002’ye ve albümin düzeyine göre malnutrisyon riski olan hastalarda postoperatif komplikasyon görülme durumunun arttığı saptanmıştır (her biri, p<0.001). Sonuç: Çalışmada, ortopedik cerrahi hastalarında, malnutrisyon prevalansının yüksek olduğu bulunmuştur. Preoperatif dönemde malnutrisyon, yaş ve kronik hastalıkların varlığı ile ilişkilidir. Malnutrisyon riski olan hastalarda hastanede kalış süresi ve postoperatif komplikasyon görülme durumu artmaktadır.

Anahtar Kelimeler

• Malnutrisyon
• NRS-2002
• ortopedik cerrahi
• postoperatif komplikasyon
• hastanede kalış süresi

Kaynakça

1. 1. Mirza Y, Özer NT, Şahin H, Gündoğan K. Assessment of the nutritional status with the nutritional risk screening-2002 in surgical patients: Single-center, descriptive study. Clin Sci Nutr. 2019; 1(1):38-43.
2. 2. World Health Organization. https://www.who.int/health-topics/malnutrition#tab=tab_1. Erişim Tar: 11.05.2021.
3. 3. Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition–an ESPEN consensus statement. Clin Nutr. 2015;34(3):335-40.
4. 4. Derin NZA, Karahan İ, Çifci A. Hastanede yatan hastalarda malnütrisyonu etkileyen faktörler. JHSM. 2018;1(3):62-7.
5. 5. Phan K, Ranson W, White SJ, et al. Thirty-Day Perioperative Complications, Prolonged Length of Stay, and Readmission Following Elective Posterior Lumbar Fusion Associated With Poor Nutritional Status. Global Spine J. 2019;9(4):417-23.
6. 6. Ellsworth B, Kamath AF. Malnutrition and total joint arthroplasty. J Nat Sci. 2016;2(3).
7. 7. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415-21.
8. 8. Ozkalkanli MY, Ozkalkanli DT, Katircioglu K, Savaci S. Comparison of tools for nutrition assessment and screening for predicting the development of complications in orthopedic surgery. Nutr Clin Pract. 2009;24(2):274-80.

9. 9. Kılıçturgay S. Malnütrisyon ve Hastaların Beslenme Durumlarının Değerlendirilmesi Enteral ve Parenteral Beslenme. Türkiye Diyetisyenler Derneği Yayını Ankara; 1996:6-16.
10. 10. Williams DG, Wischmeyer PE. Perioperative Nutrition Care of Orthopedic Surgery Patient. Tech Orthop. 2020;35(1):15-8.
11. 11. Kyle UG, Genton L, Pichard C. Hospital length of stay and nutritional status. Curr Opin Clin Nutr Metab Care. 2005;8(4):397-402.
12. 12. Öztürk H. Elektif Batın Cerrahisi Geçirecek Olgularda Preoperatif Malnütrisyonun Araştırılması [Uzmanlık Tezi]. Bolu, Türkiye: Abant İzzet Baysal Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon AD; 2015.
13. 13. Cross MB, Yi PH, Thomas CF, Garcia J, Della Valle CJ. Evaluation of malnutrition in orthopaedic surgery. JAAOS. 2014;22(3):193-9.
14. 14. Friedman AN, Fadem SZ. Reassessment of albumin as a nutritional marker in kidney disease. J Am Soc Nephrol. 2010;21(2):223-30.
15. 15. Gama-Axelsson T, Heimbürger O, Stenvinkel P, Bárány P, Lindholm B, Qureshi AR. Serum albumin as predictor of nutritional status in patients with ESRD. Clin J Am Soc Nephrol. 2012;7(9):1446-53.
16. 16. Garcia GH, Fu MC, Dines DM, Craig EV, Gulotta LV. Malnutrition: a marker for increased complications, mortality, and length of stay after total shoulder arthroplasty. J Shoulder Elb Arthroplast. 2016;25(2):193-200.
17. 17. Korfalı G, Gündoğdu H, Aydıntuğ S, ve ark. Nutritional risk of hospitalized patients in Turkey. Clin Nutr. 2009;28(5):533-7.
18. 18. Wang N, Dong Y, Huo T, Shao Y, Xing W, Li SJ. Nutritional risk, malnutrition and nutritional support among hospitalized patients in orthopedics/spinal surgery of a Hohhot teaching hospital. Asia Pac J Clin Nutr. 2016;25(2):273.
19. 19. Tangvik RJ, Tell GS, Guttormsen AB, et al. Nutritional risk profile in a university hospital population. Clin Nutr. 2015;34(4):705-11.
20. 20. Ihle C, Freude T, Bahrs C, 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.
21. 21. Wilson JM, Lunati MP, Grabel ZJ, Staley CA, Schwartz AM, Schenker ML. Hypoalbuminemia is an independent risk factor for 30-day mortality, postoperative complications, readmission, and reoperation in the operative lower extremity orthopaedic trauma patient. OTA Int. 2019;33(6):284-91.
22. 22. Heizer W, Holcombe B. Approach to the patient requiring nutritional supplementation. Textbook of Gastroenterology 1995:1044-90.
23. 23. Rapp-Kesek D, Ståhle E, Karlsson T. Body mass index and albumin in the preoperative evaluation of cardiac surgery patients. Clin Nutr. 2004;23(6):1398-404.
24. 24. Akademik Geriatri Derneği, Arıoğul S. Yaşlılarda Malnütrisyon Kılavuzu. http://www.akademikgeriatri.org/files/thn-kitap.pdf 22 Ocak 2013'de basıldı. 26.12.2020'de erişildi.
25. 25. Wu G, Liu Z, Zheng L, Quan Y, Wu Z. Prevalence of malnutrition in general surgical patients: evaluation of nutritional status and prognosis. Zhonghua wai ke za zhi [Chinese journal of surgery]. 2005;43(11):693.
26. 26. Imoberdorf R, Meier R, Krebs P, et al. Prevalence of undernutrition on admission to Swiss hospitals. Clin Nutr. 2010;29(1):38-41.
27. 27. Lambert C, Nüssler A, Biesalski HK, et al. Age-dependent risk factors for malnutrition in traumatology and orthopedic patients. Nutrition. 2017;37:60-7.
28. 28. Galvan O, Joannidis M, Widschwendter A, et al. Comparison of different scoring methods for assessing the nutritional status of hospitalised patients. Wien Klin Wochenschr. 2004;116(17-18):596-602.
29. 29. Kuzu MA, Terzioğlu H, Genç V, et al. Preoperative nutritional risk assessment in predicting postoperative outcome in patients undergoing major surgery. World J Surg. 2006;30(3):378-90.
30. 30. Bohl DD, Shen MR, Kayupov E, Della Valle CJ. Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty. J Arthroplasty. 2016;31(1):15-21.
31. 31. Adogwa O, Martin JR, Huang K, et al. Preoperative serum albumin level as a predictor of postoperative complication after spine fusion. Spine. 2014;39(18):1513-9.
32. 32. Haydock DA, Hill GL. Impaired wound healing in surgical patients with varying degrees of malnutrition. JPEN J Parenter Enteral Nutr. 1986;10(6):550-4.
33. 33. Aldebeyan S, Nooh A, Aoude A, Weber MH, Harvey EJ. Hypoalbuminaemia—a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures. Injury. 2017;48(2):436-40.
34. 34. Weimann A, Braga M, Carli F, et al. (2017). ESPEN guideline: clinical nutrition in surgery. Clinical nutrition, 2017; 36(3):623-650.