title: Is Hypoalbuminemia Associated With Septic Failure and Acute Infection After Revision Total Joint Arthroplasty? A Study of 4517 Patients From the National Surgical Quality Improvement Program.
abstract: Several studies have suggested that malnutrition may be associated with periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, strong evidence for this association is lacking. The purpose of the present study is to ask, Is the proportion of patients with hypoalbuminemia (a proxy for malnutrition) higher among patients with a septic indication for revision TJA than patients with an aseptic indication for revision TJA? Secondly, among patients undergoing revision TJA for an aseptic indication, is hypoalbuminemia predictive of subsequent early postoperative PJI?
  
  
  
  Patients undergoing revision total hip or knee arthroplasty were identified in the American College of Surgeons National Surgical Quality Improvement Program. Hypoalbuminemia was defined as serum albumin <3.5 g/dL. All analyses were adjusted for differences in demographic, comorbidity, and procedural characteristics.
  
  
  
  A total of 4517 patients met inclusion criteria, of which 715 (15.8%) underwent revision for a septic indication. Patients undergoing revision for a septic indication had a higher rate of hypoalbuminemia than patients undergoing revision for an aseptic indication (42.8% vs 11.8%; relative risk = 3.6, 95% confidence interval = 3.2-4.1, P < .001). Of the 3802 patients who underwent revision TJA for an aseptic indication, patients with hypoalbuminemia had a higher rate of early PJI after the revision than patients with normal serum albumin levels (4.5% vs 2.1%; relative risk = 2.1, 95% CI = 1.2-3.5, P = .005).
  
  
  
  These findings add to the growing body of evidence that malnutrition increases the risk of PJI after TJA. Future prospective studies should consider whether correcting malnutrition preoperatively reduces the risk of PJI after TJA.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Shen
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Erdan
authors.initials: E
authors.lastname: Kayupov
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Cvetanovich
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Della Valle
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood* / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000150:complications*; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D058996:Quality Improvement; D012042:Registries; D012086:Reoperation / Q000009:adverse effects* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018805:Sepsis; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: hypoalbuminemia; infection; malnutrition; revision; septic failure; total joint arthroplasty