Prognostic nutritional index predicts perioperative adverse events in patients undergoing hemiarthroplasty after a hip fracture

Year 2022, Volume: 39 Issue: 1, 24 - 27, 01.01.2022

Cem Yalın Kılınç , Onur Gürsan , Ahmet Acan , Emre Gultac

Abstract

The relation of the prognostic nutritional index (PNI) with perioperative adverse events (PE) has never been described in hip fracture surgery patients. Therefore, this study aimed to evaluate the impact of preoperative PNI on the outcome of patients undergoing hemiarthroplasty after a hip fracture. A total of 154 adult patients aged ≥ 65 years undergoing hemiarthroplasty after a hip fracture were included in this retrospective study. The outcomes of interest were the length of stay in hospital and PE during hospitalization, defined as death, surgical site infection, major bleeding, cardiopulmonary complications, acute renal failure, pneumonia, cerebrovascular accidents, and sepsis. PNI was calculated from the following formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Patients’ information, including demographic data, routine preoperative laboratory tests, and PNI, was collected to assess the association between these factors and the PE. Perioperative adverse events occurred in 21 (13.6%) of the patients. Older patients and those with more comorbid conditions such as heart failure, coronary artery disease, diabetes mellitus, cerebrovascular diseases, and chronic obstructive pulmonary diseases were tended to have a higher rate of PE. Patients with PE had lower PNI (45.2±4.2 vs. 51.6±5.4; p < 0.001) on admission. Multivariate analysis showed that age (OR: 2.23, 95% CI 1.15-4.45, p=0.042), presence of diabetes (OR: 2.34; 95% CI: 1.74–6.89; p =0.005) and PNI < 47.2 (OR 2.54, 95% CI 1.32-5.72, p = 0.004) were significant and independent predictors of PE. This study is the first to demonstrate that the lower preoperative PNI is associated with PE in patients undergoing hip fracture surgery.

Keywords

Prognostic Nutritional Index, Hip fracture, Surgery, Prognosis, Complication

References

• 1. Oliver D, Griffiths R, Roche J, Sahota O. Hip fracture. BMJ Clin Evid. 2007 Oct 10; 2007. pii: 1110.
• 2. Dharmarajan TS, BanikP, Hip fracture. Risk factors, preoperative assessment, and postoperative management. Postgrad Med. 2006 Jun-Jul;119(1):31-8.
• 3. Marufu TC, Mannings A, Moppett IK. Risk scoring models for predicting peri-operative morbidity and mortality in people with fragility hip fractures: Qualitative systematic review. Injury. 2015 Dec;46(12):2325-34.
• 4. Smith EB, Parvizi J, Purtill JJ. Delayed surgery for patients with femur and hip fractures-risk of deep venous thrombosis. J Trauma. 2011;70(6): E113-6.
• 5. Siu AL, Penrod JD, Boockvar KS, Koval K, Strauss E, Morrison RS. Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med. 2006;166(7):766-71.
• 6. Cheng T, Zhang GY, Liu T, Zhang XL. A meta-analysis of percutaneous compression plate versus sliding hip screw for the management of intertrochanteric fractures of the hip. J Trauma Acute Care Surg. 2012;72(5):1435-43.
• 7. Jamal Sepah Y, Umer M, Khan A, Ullah Khan Niazi A. Functional outcome, mortality, and in-hospital complications of operative treatment in elderly patients with hip fractures in the developing world. Int Orthop. 2010;34(3):431-5.
• 8. Franzo A, Francescutti C, Simon G. Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epidemiol. 2005;20(12):985-91.
• 9. Karres J, Heesakkers NA, Ultee JM, Vrouenraets BC. Predicting 30-day mortality following hip fracture surgery: evaluation of six risk prediction models. Injury 2014; 46:371–7.
• 10. Mazzola P, Ward L, Zazzetta S, et al. Association Between Preoperative Malnutrition and Postoperative Delirium After Hip Fracture Surgery in Older Adults. J Am Geriatr Soc. 2017 Jun;65(6):1222-1228.
• 11. van Wissen J, van Stijn MF, Doodeman HJ, Houdijk AP. Mini Nutritional Assessment and Mortality after Hip Fracture Surgery in the Elderly. J Nutr Health Aging. 2016;20(9):964-968.
• 12. Jones JM. The methodology of nutritional screening and assessment tools. J Hum Nutr Diet. 2002 Feb;15(1):59-71; quiz 73-5.
• 13. T. Nozoe, M. Kohno, T. Iguchi, et al. The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma, Surg. Today 42 (2012) 532–535.
• 14. Tokunaga R, Sakamoto Y, Nakagawa S, Miyamoto Y, Yoshida N, Oki E, Watanabe M, Baba H. Prognostic Nutritional Index Predicts Severe Complications, Recurrence, and Poor Prognosis in Patients with Colorectal Cancer Undergoing Primary Tumor Resection. Dis Colon Rectum. 2015 Nov;58(11):1048-5.7
• 15. Yang Z, Zhang B, Hou L, Xie Y, Cao X. Pre-operative prognostic nutritional index predicts the outcomes for triple-negative breast cancer, Tumour Biol. 35(2014) 12165–12171.
• 16. Hong S, Zhou T, Fang W, Xue C, Hu Z, Qin T, Tang Y, Chen Y, Ma Y, Yang Y, Hou X, Huang Y, Zhao H, Zhao Y, Zhang L. The prognostic nutritional index (PNI) predicts overall survival of small-cell lung cancer patients. 2014 Dec;35(12):12165-71.
• 17. Cheng YL, Sung SH, Cheng HM, Hsu PF, Guo CY, Yu WC, Chen CH. Prognostic Nutritional Index and the Risk of Mortality in Patients with Acute Heart Failure. J Am Heart Assoc. 2017 Jun 25;6(6).
• 18. Hayıroğlu Mİ, Keskin M, Keskin T, Uzun AO, Altay S, Kaya A, Öz A, Çinier G, Güvenç TS, Kozan Ö. A Novel Independent Survival Predictor in Pulmonary Embolism: Prognostic Nutritional Index. Clin Appl Thromb Hemost. 2018 May;24(4):633-639.
• 19. Okada S, Shimada J, Teramukai S, Kato D, Tsunezuka H, Miyata N, Ishihara S, Furuya T, Nakazono C, Ishikawa N, Inoue M. Risk Stratification According to the Prognostic Nutritional Index for Predicting Postoperative Complications After Lung Cancer Surgery. Ann Surg Oncol. 2018 May;25(5):1254-1261.
• 20. Ren H, Wu L, Hu W, Ye X, Yu B. Prognostic value of the c-reactive protein/prognostic nutritional index ratio after hip fracture surgery in the elderly population. Oncotarget. 2017 May 24;8(37):61365-61372.
• 21. Christopher P. Miller, Rafael A. Buerba, Michael P. Leslie. Preoperative Factors and Early Complications Associated with Hemiarthroplasty and Total Hip Arthroplasty for Displaced Femoral Neck Fractures. Geriatr Orthop Surg Rehabil. 2014 Jun; 5(2): 73–81.
• 22. 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 Feb;48(2):436-440.
• 23. Lee JY, Kim HI, Kim YN, Hong JH, Alshomimi S, An JY, Cheong JH, Hyung WJ, Noh SH, Kim CB. Clinical Significance of the Prognostic Nutritional Index for Predicting Short- and Long-Term Surgical Outcomes After Gastrectomy: A Retrospective Analysis of 7781 Gastric Cancer Patients. Medicine (Baltimore). 2016 May;95(18): e3539.
• 24. Oe S, Togawa D, Yamato Y, Hasegawa T, Yoshida G, Kobayashi S, Yasuda T, Banno T, Arima H, Mihara Y, Ushirozako H, Yamada T, Matsuyama Y. Preoperative age and prognostic nutritional index are useful factors for evaluating postoperative delirium among patients with adult spinal deformity. Spine (Phila Pa 1976). 2019 Apr 1;44(7):472-478.
• 25. Mori S, Usami N, Fukumoto K, Mizuno T, Kuroda H, Sakakura N, Yokoi K, Sakao Y. The Significance of the Prognostic Nutritional Index in Patients with Completely Resected Non-Small Cell Lung Cancer. PLoS One. 2015 Sep 10;10(9): e0136897.