Nutritional status and postoperative recovery outcomes in patients undergoing orthopedic surgery

Malnutrition is a prevalent yet often overlooked phenomenon among orthopedic patients, and it can adversely affect postoperative recovery and functional outcomes.

To explore the relationships between preoperative nutritional status and postoperative recovery, complications, functional and healthcare utilization in the postoperative patients undergoing major orthopedic surgery.

The retrospective cohort study was conducted at a tertiary orthopedic center and included adults who underwent major orthopedic surgery from January 2017 through December 2023. Preoperative nutritional assessment was conducted using the Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, anthropometric measurements, and laboratory parameters. The patients were classified into malnourished and well-nourished. Independent-samples t-tests and chi-square tests were used to compare postoperative outcomes.

Of 1,500 patients, 580 (38.7) were found to be malnourished. The older patients with malnutrition had a higher comorbidity and frailty score. They all exhibited a longer first ambulation time (44.6 vs. 29.4 h), less early mobilization (29.3% vs. 62.1%), a longer length of stay (10.9 vs. 7.0 days), and higher postoperative pain scores (all p < 0.001). Postoperative complications, such as surgical site infection, pneumonia, sepsis, and thromboembolic events, were very common in the malnourished group. There was poorer functional recovery, with lower Barthel Index scores at discharge and at 3 months, less independent mobility, and a decreased return to pre-injury activity. Malnourished patients were also more frequently readmitted within 30 and 90 days and consumed a higher amount of healthcare resources. Malnutrition was an independent predictor of delayed walking (aOR 2.84, 95%CI 2.21-3.65), extended hospitalization (aOR 3.12, 95%CI 2.45-3.97), and higher levels of post-operative pain (β = +1.08, 95%CI 0.92-1.24; all p < 0.001). It also contributed to the occurrence of various postoperative complications, including surgical-site infection (aOR 2.67), pneumonia (aOR 2.41), and sepsis (aOR 2.76). Functional rehabilitation became more difficult due to increased chances of a poor Barthel Index score at discharge (aOR 3.45).

Preoperative malnutrition is significantly related to delayed recovery, more complications, worse functional outcomes, and increased healthcare use after orthopedic surgery. Timely nutritional screening and intervention could help enhance outcomes in the postoperative period.