Perioperative nutrition assessment in musculoskeletal trauma patients: Dietitian evaluation is superior to serum chemistries or modified screening questionnaire for risk stratification

Nathan R. Hendrickson, Natalie Glass, Jocelyn Compton, Brandon G. Wilkinson, J. Lawrence Marsh, Michael C. Willey

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Introduction: Malnutrition is a potentially modifiable risk factor associated with increased hospital charges, major wound complication, and fracture non-union after orthopaedic surgery. The goal of this study was to examine the relationship between three nutrition screening tools and postoperative complications in patients undergoing acute fracture fixation. Methods: Patients aged 18 or older undergoing acute operative fracture fixation at a Level I academic trauma center were screened upon admission using a malnutrition screening questionnaire (MSQ), and classified as low-, moderate- or high risk. Patients at moderate-to-high risk were assessed for clinical malnutrition by dietitian. Serum albumin, transferrin, total lymphocyte count, and 25(OH) Vitamin D were measured preoperatively. Primary outcome measures included twelve-month postoperative surgical and medical complications obtained by retrospective chart review. Results: Of 373 patients, 17% were moderate-to-high risk of malnutrition by MSQ. Clinical malnutrition was diagnosed by dietitian in 4.3% of patients assessed. Nearly half of all subjects had deficiency in one or more serum biomarkers. Cost of biomarker assays was $624 per patient. Medical or surgical complications occurred in 19% of patients. Dietitian diagnosed malnutrition (clinical malnutrition) was the strongest predictor of complication (OR 3.49, p = 0.017). Hypoalbuminemia was also associated with increased complication risk (OR 1.79, p = 0.045). MSQ score was not correlated with postoperative complication. Conclusions: Among the examined malnutrition screening tools, clinical malnutrition had the strongest association with postoperative complication. Hypoalbuminemia was associated with increased odds of complication, however there was a large false positive rate with all tested serum chemistries and high associated hospital charges compared to dietitian assessment. MSQ was a poor predictor of malnutrition and clinical outcome. Dietetic assessment is advised for orthopaedic trauma patients.

Original languageEnglish (US)
Pages (from-to)97-102
Number of pages6
JournalClinical Nutrition ESPEN
Volume29
DOIs
StatePublished - Feb 2019
Externally publishedYes

Bibliographical note

Funding Information:
This research was supported by the University of Iowa Injury Prevention Research Center through funding from the Centers for Disease Control and Prevention (Grant # 1R49CE002108 ). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Publisher Copyright:
© 2018 European Society for Clinical Nutrition and Metabolism

Keywords

  • Complications
  • Malnutrition
  • Nutrition screening
  • Orthopaedic trauma
  • Risk stratification

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