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The Influence of Malnutrition on Postoperative Complications Following Open Reduction and Internal Fixation for
Jad Lawand1, Jeffrey Hauck2, Umar Ghilzai2
1University of Texas Medical Branch, Galveston, TX.
Purpose:
Malnutrition has been associated with increased postoperative complications, yet its influence on distal radius open reduction and internal fixation (ORIF) remains unexplored. This study compared the impact of malnutrition on complications following ORIF within both 90-day and 2-year postoperative periods.
Methods:
This retrospective cohort study used electronic medical records. Patients were divided into two cohorts: those with malnutrition, defined by having one or more of the following laboratory findings: albumin <3.5 g/dL; transferrin <204 mg/dL; or total leukocyte count <1,500/μL within 3 months prior to surgery, and those without malnutrition. Propensity score matching accounted for demographic and comorbidity differences. Risk ratios (RRs) were calculated to assess relative complication risks between the cohorts.
Results:
The study included 1,877 patients in the malnutrition group and 18,168 in the control group, with 1,871 per cohort after matching. Over 90 days, malnutrition patients had higher rates of skin infection (RR: 2.00; 95% confidence interval [CI]: 1.39-2.88), deep vein thrombosis (RR: 2.70; 95% CI: 1.68-4.33), sepsis (RR: 2.92; 95% CI: 1.56-5.47), wound disruption (RR: 2.11; 95% CI: 1.22-3.62), pulmonary embolism (RR: 2.50; 95% CI: 1.41-4.45), and acute kidney disease (RR: 2.78; 95% CI: 1.34-5.76). There were no significant differences in rates of nerve injury, myocardial infarction, or stroke. At 2 years, malnutrition at the time of the initial injury was associated with increased risk of hardware loosening following ORIF (RR: 1.79; 95% CI: 1.18-2.71) and nonunion (RR: 2.49; 95% CI: 1.57-3.94).
Conclusions:
Malnutrition significantly increases the risk of postoperative complications following ORIF for distal radius fractures. Within 90 days, malnourished patients experienced higher rates of skin infections, deep vein thrombosis, sepsis, wound disruption, pulmonary embolism, and acute kidney disease. At 2 years, malnutrition at the time of injury was associated with elevated risks of loosening of ORIF hardware and nonunion.
Type Of Study/Level Of Evidence:
Prognostic II.
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