title: Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications.
abstract: The records of 217 consecutive patients who underwent a primary total hip or total knee arthroplasty were reviewed for preoperative and postoperative nutritional status. Fifty-seven patients had a lymphocyte count of less than 1,500 cells/mm3, four patients had an albumin level of less than 3.5 g/dL, and two patients had both, giving a 27% incidence of indices indicative of preoperative nutritional depletion. Patients without wound complications had an average preoperative lymphocyte count of 1,995 (+/- 631), compared to 1,638 (+/- 491) for those with persistent serous drainage from their wounds, and 1,553 (+/- 419) for those patients with a major wound complication (P = .002). The average albumin levels were 4.30 (+/- 0.33), 4.22 (+/- 0.31), and 4.13 (+/- 0.54), respectively. Patients with rheumatoid arthritis were compared to those with osteoarthritis and were found to have significantly lower preoperative albumin levels. They were three times as likely to develop a major wound complication. Patients on immunosuppressive medications had significantly lower preoperative lymphocyte counts, lower albumin levels, and higher complication rates (P = .04). After operation, lymphocyte counts of all patients dropped to an average of 57% of their preoperative values, and albumin levels dropped to 72% of their preoperative values. No nutritional parameters had returned to their preoperative levels by 10 postoperative days. For all patients, a preoperative lymphocyte count of less than 1,500 cells/mm was associated with a five times greater frequency of developing a major wound complication, and an albumin level of less than 3.5 g/dL had a seven times greater frequency.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Crystal Clinic, Akron, Ohio 44333.
authors.forename: K A
authors.initials: KA
authors.lastname: Greene
authors.forename: A H
authors.initials: AH
authors.lastname: Wilde
authors.forename: B N
authors.initials: BN
authors.lastname: Stulberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007595:Joint Prosthesis; D007958:Leukocyte Count; D008875:Middle Aged; D009752:Nutritional Status; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology
chemical_list: D012709:Serum Albumin