Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture
Serum albumin level is the most well-established serum marker of malnutrition, with a serum albumin concentration
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| Veröffentlicht in: | Journal of bone and joint surgery. American volume 2017-12, Vol.99 (24), p.2110-2118 |
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| container_title | Journal of bone and joint surgery. American volume |
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| creator | Bohl, Daniel D. Shen, Mary R. Hannon, Charles P. Fillingham, Yale A. Darrith, Brian Della Valle, Craig J. |
| description | Serum albumin level is the most well-established serum marker of malnutrition, with a serum albumin concentration |
| doi_str_mv | 10.2106/JBJS.16.01620 |
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A retrospective cohort study of geriatric patients (≥65 years of age) undergoing a hip fracture surgical procedure as part of the American College of Surgeons National Surgical Quality Improvement Program was conducted. Outcomes were compared between patients with and without hypoalbuminemia. All comparisons were adjusted for baseline and procedural differences between populations, and patients with missing serum albumin concentration were included in analyses using a missing data indicator.
There were 29,377 geriatric patients undergoing a hip fracture surgical procedure who met inclusion criteria; of these patients, 17,651 (60.1%) had serum albumin available for analysis. The prevalence of hypoalbuminemia was 45.9%. Following adjustment for baseline and procedural characteristics, the risk of death was inversely associated with serum albumin concentration as a continuous variable (adjusted relative risk, 0.59 [95% confidence interval (CI), 0.53 to 0.65]; p < 0.001). In comparison with patients with normal albumin concentration, patients with hypoalbuminemia had higher rates of death (9.94% compared with 5.53% [adjusted relative risk, 1.52 (95% CI, 1.37 to 1.70); p < 0.001]), sepsis (1.19% compared with 0.53% [adjusted relative risk, 1.92 (95% CI, 1.36 to 2.72); p < 0.001]), and unplanned intubation (2.64% compared with 1.47% [adjusted relative risk, 1.51 (95% CI, 1.21 to 1.88); p < 0.001]). The mean length of stay (and standard deviation) was longer among patients with hypoalbuminemia at 5.67 ± 4.68 days compared with those without hypoalbuminemia at 4.99 ± 3.95 days; the adjusted difference was 0.50 day (95% CI, 0.38 to 0.63 day; p < 0.001). However, the rate of readmission did not differ (p = 0.054) between patients with hypoalbuminemia (10.91%) and those without hypoalbuminemia (9.03%); the adjusted relative risk was 1.10 (95% CI, 1.00 to 1.21).
Hypoalbuminemia is a powerful independent risk factor for mortality following a surgical procedure for geriatric hip fracture. These data suggest that further investigation into postoperative nutritional supplementation is warranted to decrease the risk of complications.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.]]></description><identifier>ISSN: 0021-9355</identifier><identifier>EISSN: 1535-1386</identifier><identifier>DOI: 10.2106/JBJS.16.01620</identifier><identifier>PMID: 29257017</identifier><language>eng</language><publisher>United States: The Journal of Bone and Joint Surgery, Inc</publisher><subject>Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip - adverse effects ; Arthroplasty, Replacement, Hip - methods ; Biomarkers - blood ; Cohort Studies ; Female ; Fracture Fixation, Intramedullary - adverse effects ; Fracture Fixation, Intramedullary - methods ; Geriatric Assessment - methods ; Hip Fractures - diagnostic imaging ; Hip Fractures - mortality ; Hip Fractures - surgery ; Hospital Mortality - trends ; Humans ; Injury Severity Score ; Kaplan-Meier Estimate ; Length of Stay ; Male ; Multivariate Analysis ; Postoperative Complications - mortality ; Postoperative Complications - physiopathology ; Prognosis ; Retrospective Studies ; Serum Albumin - analysis ; Survival Rate ; Treatment Outcome</subject><ispartof>Journal of bone and joint surgery. American volume, 2017-12, Vol.99 (24), p.2110-2118</ispartof><rights>The Journal of Bone and Joint Surgery, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4048-de3b2b1e07dd850add3e3953a156e85e5a3d88111ae17bfca516946f645eaf433</citedby><cites>FETCH-LOGICAL-c4048-de3b2b1e07dd850add3e3953a156e85e5a3d88111ae17bfca516946f645eaf433</cites><orcidid>0000-0003-2913-7513</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29257017$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bohl, Daniel D.</creatorcontrib><creatorcontrib>Shen, Mary R.</creatorcontrib><creatorcontrib>Hannon, Charles P.</creatorcontrib><creatorcontrib>Fillingham, Yale A.</creatorcontrib><creatorcontrib>Darrith, Brian</creatorcontrib><creatorcontrib>Della Valle, Craig J.</creatorcontrib><title>Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture</title><title>Journal of bone and joint surgery. American volume</title><addtitle>J Bone Joint Surg Am</addtitle><description><![CDATA[Serum albumin level is the most well-established serum marker of malnutrition, with a serum albumin concentration <3.5 g/dL considered to be suggestive of malnutrition. The purpose of this study was to test if serum albumin level is associated with death, specific postoperative complications (e.g., pneumonia), length of hospital stay, and readmission following a surgical procedure for geriatric hip fracture.
A retrospective cohort study of geriatric patients (≥65 years of age) undergoing a hip fracture surgical procedure as part of the American College of Surgeons National Surgical Quality Improvement Program was conducted. Outcomes were compared between patients with and without hypoalbuminemia. All comparisons were adjusted for baseline and procedural differences between populations, and patients with missing serum albumin concentration were included in analyses using a missing data indicator.
There were 29,377 geriatric patients undergoing a hip fracture surgical procedure who met inclusion criteria; of these patients, 17,651 (60.1%) had serum albumin available for analysis. The prevalence of hypoalbuminemia was 45.9%. Following adjustment for baseline and procedural characteristics, the risk of death was inversely associated with serum albumin concentration as a continuous variable (adjusted relative risk, 0.59 [95% confidence interval (CI), 0.53 to 0.65]; p < 0.001). In comparison with patients with normal albumin concentration, patients with hypoalbuminemia had higher rates of death (9.94% compared with 5.53% [adjusted relative risk, 1.52 (95% CI, 1.37 to 1.70); p < 0.001]), sepsis (1.19% compared with 0.53% [adjusted relative risk, 1.92 (95% CI, 1.36 to 2.72); p < 0.001]), and unplanned intubation (2.64% compared with 1.47% [adjusted relative risk, 1.51 (95% CI, 1.21 to 1.88); p < 0.001]). The mean length of stay (and standard deviation) was longer among patients with hypoalbuminemia at 5.67 ± 4.68 days compared with those without hypoalbuminemia at 4.99 ± 3.95 days; the adjusted difference was 0.50 day (95% CI, 0.38 to 0.63 day; p < 0.001). However, the rate of readmission did not differ (p = 0.054) between patients with hypoalbuminemia (10.91%) and those without hypoalbuminemia (9.03%); the adjusted relative risk was 1.10 (95% CI, 1.00 to 1.21).
Hypoalbuminemia is a powerful independent risk factor for mortality following a surgical procedure for geriatric hip fracture. These data suggest that further investigation into postoperative nutritional supplementation is warranted to decrease the risk of complications.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.]]></description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Arthroplasty, Replacement, Hip - methods</subject><subject>Biomarkers - blood</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Fracture Fixation, Intramedullary - adverse effects</subject><subject>Fracture Fixation, Intramedullary - methods</subject><subject>Geriatric Assessment - methods</subject><subject>Hip Fractures - diagnostic imaging</subject><subject>Hip Fractures - mortality</subject><subject>Hip Fractures - surgery</subject><subject>Hospital Mortality - trends</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Kaplan-Meier Estimate</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - physiopathology</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Serum Albumin - analysis</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>0021-9355</issn><issn>1535-1386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo90MFv0zAUx3FrArEyOO6KfOSS8p4dO8lxVHRjmsSkwtly4pfNw6mLnbTaf0-zDk5Pevrod_gydomwFAj6y-3X280S9RJQCzhjC1RSFShr_YYtAAQWjVTqnL3P-QkAyhKqd-xcNEJVgNWC0YbSNPCr0E6D3_L7RM53Y-abKe393gZut47fxzzGHSU7-j3xVZxSJr6OIcSD3z7M9oHSM-9j4teUvB2T7_iN3_F1st04JfrA3vY2ZPr4ei_Yr_W3n6ub4u7H9ffV1V3RlVDWhSPZihYJKudqBdY5SbJR0qLSVCtSVrq6RkRLWLV9ZxXqptS9LhXZvpTygn0-7e5S_DNRHs3gc0ch2C3FKRtsqroSIMr6SIsT7VLMOVFvdskPNj0bBDOXNXNZg9q8lD36T6_TUzuQ-6__pTyC8gQOMYyU8u8wHSiZR7JhfDQwx9dCFuJoUQiAYn7V8i9134Qy</recordid><startdate>20171220</startdate><enddate>20171220</enddate><creator>Bohl, Daniel D.</creator><creator>Shen, Mary R.</creator><creator>Hannon, Charles P.</creator><creator>Fillingham, Yale A.</creator><creator>Darrith, Brian</creator><creator>Della Valle, Craig J.</creator><general>The Journal of Bone and Joint Surgery, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2913-7513</orcidid></search><sort><creationdate>20171220</creationdate><title>Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture</title><author>Bohl, Daniel D. ; Shen, Mary R. ; Hannon, Charles P. ; Fillingham, Yale A. ; Darrith, Brian ; Della Valle, Craig J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4048-de3b2b1e07dd850add3e3953a156e85e5a3d88111ae17bfca516946f645eaf433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Arthroplasty, Replacement, Hip - methods</topic><topic>Biomarkers - blood</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fracture Fixation, Intramedullary - adverse effects</topic><topic>Fracture Fixation, Intramedullary - methods</topic><topic>Geriatric Assessment - methods</topic><topic>Hip Fractures - diagnostic imaging</topic><topic>Hip Fractures - mortality</topic><topic>Hip Fractures - surgery</topic><topic>Hospital Mortality - trends</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Kaplan-Meier Estimate</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - physiopathology</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Serum Albumin - analysis</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bohl, Daniel D.</creatorcontrib><creatorcontrib>Shen, Mary R.</creatorcontrib><creatorcontrib>Hannon, Charles P.</creatorcontrib><creatorcontrib>Fillingham, Yale A.</creatorcontrib><creatorcontrib>Darrith, Brian</creatorcontrib><creatorcontrib>Della Valle, Craig J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of bone and joint surgery. American volume</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bohl, Daniel D.</au><au>Shen, Mary R.</au><au>Hannon, Charles P.</au><au>Fillingham, Yale A.</au><au>Darrith, Brian</au><au>Della Valle, Craig J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture</atitle><jtitle>Journal of bone and joint surgery. American volume</jtitle><addtitle>J Bone Joint Surg Am</addtitle><date>2017-12-20</date><risdate>2017</risdate><volume>99</volume><issue>24</issue><spage>2110</spage><epage>2118</epage><pages>2110-2118</pages><issn>0021-9355</issn><eissn>1535-1386</eissn><abstract><![CDATA[Serum albumin level is the most well-established serum marker of malnutrition, with a serum albumin concentration <3.5 g/dL considered to be suggestive of malnutrition. The purpose of this study was to test if serum albumin level is associated with death, specific postoperative complications (e.g., pneumonia), length of hospital stay, and readmission following a surgical procedure for geriatric hip fracture.
A retrospective cohort study of geriatric patients (≥65 years of age) undergoing a hip fracture surgical procedure as part of the American College of Surgeons National Surgical Quality Improvement Program was conducted. Outcomes were compared between patients with and without hypoalbuminemia. All comparisons were adjusted for baseline and procedural differences between populations, and patients with missing serum albumin concentration were included in analyses using a missing data indicator.
There were 29,377 geriatric patients undergoing a hip fracture surgical procedure who met inclusion criteria; of these patients, 17,651 (60.1%) had serum albumin available for analysis. The prevalence of hypoalbuminemia was 45.9%. Following adjustment for baseline and procedural characteristics, the risk of death was inversely associated with serum albumin concentration as a continuous variable (adjusted relative risk, 0.59 [95% confidence interval (CI), 0.53 to 0.65]; p < 0.001). In comparison with patients with normal albumin concentration, patients with hypoalbuminemia had higher rates of death (9.94% compared with 5.53% [adjusted relative risk, 1.52 (95% CI, 1.37 to 1.70); p < 0.001]), sepsis (1.19% compared with 0.53% [adjusted relative risk, 1.92 (95% CI, 1.36 to 2.72); p < 0.001]), and unplanned intubation (2.64% compared with 1.47% [adjusted relative risk, 1.51 (95% CI, 1.21 to 1.88); p < 0.001]). The mean length of stay (and standard deviation) was longer among patients with hypoalbuminemia at 5.67 ± 4.68 days compared with those without hypoalbuminemia at 4.99 ± 3.95 days; the adjusted difference was 0.50 day (95% CI, 0.38 to 0.63 day; p < 0.001). However, the rate of readmission did not differ (p = 0.054) between patients with hypoalbuminemia (10.91%) and those without hypoalbuminemia (9.03%); the adjusted relative risk was 1.10 (95% CI, 1.00 to 1.21).
Hypoalbuminemia is a powerful independent risk factor for mortality following a surgical procedure for geriatric hip fracture. These data suggest that further investigation into postoperative nutritional supplementation is warranted to decrease the risk of complications.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.]]></abstract><cop>United States</cop><pub>The Journal of Bone and Joint Surgery, Inc</pub><pmid>29257017</pmid><doi>10.2106/JBJS.16.01620</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-2913-7513</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Hip - methods Biomarkers - blood Cohort Studies Female Fracture Fixation, Intramedullary - adverse effects Fracture Fixation, Intramedullary - methods Geriatric Assessment - methods Hip Fractures - diagnostic imaging Hip Fractures - mortality Hip Fractures - surgery Hospital Mortality - trends Humans Injury Severity Score Kaplan-Meier Estimate Length of Stay Male Multivariate Analysis Postoperative Complications - mortality Postoperative Complications - physiopathology Prognosis Retrospective Studies Serum Albumin - analysis Survival Rate Treatment Outcome |
| title | Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture |
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