Preoperative Nutritional Testing Before Midfoot Fusion Is Infrequent, and With the Numbers Available, No Association Between Hypoalbuminemia and Postoperative Complications Could Be Detected: A Propensity-Matched Cohort Study
Alexander J. Baur, Ethan C. Gazan, Jared Sasaki, Taylor Anthony, Troy S. WatsonBackground
Adequate nutrition is essential for wound healing and postoperative recovery. Preoperative screening may identify high-risk patients and improve outcomes. This study aimed to determine whether abnormal preoperative nutritional laboratory values are associated with 90-day and 1-year complications including pseudarthrosis following midfoot fusion.
Methods:
We conducted a retrospective propensity score–matched cohort study using the TriNetX research network of more than 147 million patients, evaluating patients undergoing midfoot fusion with available preoperative nutritional laboratory values. Rates of preoperative laboratory testing were assessed, followed by propensity score–matched analyses comparing patients with abnormal and normal values. Ninety-day and 1-year postoperative complications were evaluated.
Results:
A total of 5667 patients underwent midfoot fusion. Preoperative nutritional laboratory markers were infrequently obtained (albumin 58.9%, leukocytes 36.0%, transferrin 3.2%, and prealbumin 1.9%) and often within normal limits (albumin 89.9%, leukocytes 99.5%, transferrin 79.7%, and prealbumin 91.0%). With the numbers available, no association could be detected between preoperative hypoalbuminemia and 90-day wound disruption (risk ratio [RR] 1.10, 95% CI 0.61-1.98), SSI (SSI; RR 0.96, 95% CI 0.54-1.68), hardware infection (RR 1.33, 95% CI 0.70-2.56), return to emergency department (ED; RR 1.05, 95% CI 0.70-1.59), or readmission (RR 1.13, 95% CI 0.88-1.45). With the numbers available, no association could be detected at 1 year postoperatively for pseudarthrosis (RR 1.06, 95% CI 0.55-2.07), wound disruption (RR 1.03, 95% CI 0.64-1.68), SSI (RR 1.03, 95% CI 0.64-1.67), hardware infection (RR 1.14, 95% CI 0.71-1.83), return to ED (RR 1.07, 95% CI 0.83-1.39), readmission (RR 1.18, 95% CI 0.95-1.46), hardware removal (RR 1.07, 95% CI 0.66-1.71), pneumonia (RR 0.79, 95% CI 0.36-1.71), and venous thromboembolism (RR 1.23, 95% CI 0.60-2.52).
Conclusions:
Preoperative nutritional laboratory markers are infrequently obtained and are rarely abnormal when measured. With the numbers available, no association could be detected between preoperative hypoalbuminemia and increased 90-day or 1-year complications including pseudarthrosis following midfoot fusion.
Level of Evidence:
Level III, retrospective cohort study.