title: Hypoalbuminemia More Than Morbid Obesity is an Independent Predictor of Complications After Total Hip Arthroplasty.
abstract: Health care reform is directing clinical practice towards improving outcomes and minimizing complications. Preoperative identification of high-risk patients and modifiable risk factors present opportunity for clinical research. A total of 49,475 total hip arthroplasty patients were identified from National Surgical Quality Improvement Program between 2006 and 2013. We compared morbidly obese patients (BMI≥40 kg/m(2)) and non-morbidly obese patients (BMI 18.5-40 kg/m(2)). We also compared patients with hypoalbuminemia (serum albumin <3.5 g/dL) against those with normal albumin. Our study demonstrates that hypoalbuminemia is a significant risk factor for mortality and major morbidity among total hip arthroplasty patients, while morbid obesity was only associated with an increased risk of superficial surgical site infection. Impressively, hypoalbuminemia patients carried a 5.94-fold risk of 30-day mortality.
authors.affiliation: Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Walls
authors.affiliation: Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daniel
authors.initials: D
authors.lastname: Abraham
authors.affiliation: Department of Orthopaedic Surgery, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Nelson
authors.affiliation: Department of Orthopaedic Surgery, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Atul F
authors.initials: AF
authors.lastname: Kamath
authors.affiliation: Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nabil M
authors.initials: NM
authors.lastname: Elkassabany
authors.affiliation: Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jiabin
authors.initials: J
authors.lastname: Liu
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality*; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications*; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection; D014481:United States / Q000453:epidemiology
keywords: 30-days; hypoalbuminemia; morbid obesity; morbidity; mortality; total hip arthroplasty