Lower post-operative geriatric nutritional risk index is associated with increased complications and re-operation...

Nutritional status influences post-operative recovery and complication risk across orthopedic procedures, yet its role in shoulder arthroplasty remains poorly defined. The purpose of this study was to evaluate whether post-operative Geriatric Nutritional Risk Index (GNRI) is associated with complications and outcomes following total shoulder arthroplasty (TSA).

A retrospective comparative study was performed of patients who underwent primary anatomic or reverse TSA with minimum 2-year follow-up. Pre-operative and post-operative GNRI values were calculated from serum albumin and body weight. Patients were classified as nutritionally normal (GNRI ≥ 109) or at risk (GNRI < 109). Complications, re-operation, range of motion (ROM), patient-reported outcomes (PROs) (American Shoulder and Elbow Surgeons, visual analog scale pain, Western Ontario Osteoarthritis of the Shoulder Index, and Single Assessment Numeric Evaluation), and expectation-based patient satisfaction were compared between groups. Logistic regression assessed GNRI as an independent predictor of complications after adjustment for age, body mass index, diagnosis, and comorbidities.

A total of 175 patients met the study criteria, of which 50 (28.6%) were classified as nutritionally at risk post-operatively. The atrisk group had a greater post-operative decline in GNRI (-4.9 ± 10.6 vs. +0.7 ± 5.4; P < .001). Improvements in ROM, PROs, Minimal Clinically Important Difference attainment, expectations, and satisfaction were similar between GNRI groups at the final follow-up (all P > .05). Post-operative complications were more frequent among patients with GNRI < 109, including any complication (18.0% vs. 2.4%; P = .001), re-operation (10.0% vs. 2.4%; P = .044), and non-surgical medical complications (8.0% vs. 0.0%; P = .006). On multivariable analysis adjusted for age and sex, post-operative GNRI < 109 was independently associated with increased odds of any complication (odds ratio: 13.19; P < .001) and re-operation (odds ratio: 6.21; P = .034). No independent associations were observed between post-operative GNRI < 109 and American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, visual analog scale pain, or Veterans RAND 12-Item Health Survey mental or physical component scores (all P ≥ .05).

Lower post-operative GNRI was strongly associated with increased complication and re-operation rates following TSA, with GNRI < 109 conferring more than a 13-fold higher odds of any complication and a 6-fold higher odds of re-operation. Despite these findings, long-term PROs and ROM were similar between nutritional groups. GNRI screening or monitoring may identify patients at risk for complication following TSA.