Low Preoperative Albumin Levels Predict Adverse Outcomes After Total Joint Arthroplasty

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Low serum albumin is a known risk factor for complications after hip or knee arthroplasty.
• This study expands the investigation to all primary and revision total joint arthroplasties.

Purpose of the Study:

• To determine the association between preoperative serum albumin levels and 30-day postoperative complications across all total joint arthroplasties.
• To identify specific adverse outcomes linked to hypoalbuminemia in this patient population.

Main Methods:

• Analysis of 135,008 patients from the U.S. National Surgical Quality Improvement Program (NSQIP) database (2005-2015).
• Patients were categorized by preoperative albumin levels (normal ≥3.5 g/dL vs. hypoalbuminemic <3.5 g/dL).
• Multivariate regression analysis was used to identify independent associations between hypoalbuminemia and outcomes, controlling for comorbidities.

Main Results:

• Patients with hypoalbuminemia (<3.5 g/dL) exhibited significantly higher rates of postoperative complications.
• These complications included cardiac arrest, myocardial infarction, cerebrovascular accident, surgical site infection, sepsis, pneumonia, renal insufficiency, and unplanned intubation (all p < 0.005).
• A higher incidence of return to the operating room within 30 days was also observed in the hypoalbuminemic group.

Conclusions:

• Preoperative hypoalbuminemia is a significant independent risk factor for adverse 30-day postoperative outcomes in all total joint arthroplasties.
• Low albumin levels are associated with increased risk of infection, pneumonia, sepsis, and myocardial infarction.
• Interventions to improve preoperative serum albumin concentrations are warranted to mitigate these risks.