Evidence map›Paper›PMID 39694920›Full record

ArticleArchives of orthopaedic and trauma surgery2024

Is it time to Reassess The Role of Preoperative HypoalbuminemiaAmong Geriatric Distal Femur Fracture Patients?

Eric H Tischler, Jake R McDermott, Shivasuryan Vummidi, Samer A Mahmoud, Jonathan M Gross, Aden N Malik, Nishant Suneja

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Article in Archives of orthopaedic and trauma surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

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1citing papers in PubMed, 1 pooled it
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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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1 citing paper in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Eric H TischlerDepartment of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA.
Jake R McDermottDepartment of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA.
Shivasuryan VummidiDepartment of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA.
Samer A MahmoudDepartment of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA.
Jonathan M GrossDepartment of Orthopaedic Surgery, Northwell Health -Staten Island University Hospital, 375 Seguine Avenue, Staten Island, NY, 10309, USA.
Aden N MalikDepartment of Orthopaedic Surgery, Lincoln Hospital, 234 East 149th Street, Bronx, NY, 10451, USA.
Nishant SunejaDepartment of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts, 02115, USA. nsuneja@bwh.harvard.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHypoalbuminemia, blanketly defined as Albumin < 3.5 g/dL, is often utilized as a threshold associated with postoperative complications and mortality among orthopedic and non-orthopedic surgical procedures. Albumin level is influenced by a myriad of factors including liver function, malnutrition, and inflammation. This study evaluates the role preoperative albumin as an independent risk factor for mortality and increased length of stay (LOS) among distal femur fracture (DFF) patients.

methodsBetween 2010 and 2019, the National Surgical Quality Improvement Program (NSQIP) identified isolated closed distal femur fractures preoperative albumin levels using International Classification of Diseases 9th and 10th revisions (ICD9/ICD10) codes [S72.4*; 821.2*]. Albumin was categorized as both continuous and categorical variables: marked hypoalbuminemia (< 2.5 g/dL), mild hypoalbuminemia (2.5-3.5 g/dL), normal albuminemia (3.5-4.5 g/dL) or hyperalbuminemia (> 4.5 g/dL). Primary outcomes included in-hospital mortality and LOS.

resultsThe incidence rate of hypoalbuminemia was 54.6% (419/767). Multivariable logistic regression analysis demonstrated that when compared to patients with baseline marked hypoalbuminemia, patients with mild hypoalbuminemia and normal serum albumin reported a respective 82% (OR 0.18, 95% CI [0.04, 0.71], p = 0.014) and 80% (OR: 0.20, 95% CI [0.05, 0.89], p = 0.034) decreased odds of in-hospital mortality. Similarly, a 53.7% (OR 0.46, 95% CI [0.23, 0.94], p = 0.033), 71.1% (OR 0.29, 95% CI [0.14, 0.60], p = 0.001), and 82.8% (OR 0.17, 95% [0.04, 0.75], p = 0.020) decreased odds of exceeding mean LOS was observed among mild hypoalbuminemic, normal, and hyperalbuminemic patients compared to patients with baseline marked hypoalbuminemia.

conclusionPreoperative hypoalbuminemia is an independent risk factor for increased LOS and mortality among DFFs, controlling for confounding factors. Prospective investigation of albumin risk stratification is warranted to differentiate contributable effects of chronic malnutrition and traumatic inflammatory albumin downregulation among geriatric trauma patients. LEVEL OF EVIDENCE: Prognostic Level III.

Indexed as

Femoral FracturesHypoalbuminemiaLength of StayAgedAged, 80 and overFemaleFemoral Fractures, DistalHospital MortalityHumansMaleMiddle AgedPostoperative ComplicationsPreoperative PeriodRetrospective StudiesRisk FactorsAlbuminDistal femur fractureFragility FractureGeriatricHypoalbuminemiaLength of StayMalnutritionOrthopedic trauma

Identifiers

PMID39694920

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.