Perioperative nutrition assessment in musculoskeletal trauma patients: Dietitian evaluation is superior to serum chemistries or modified screening questionnaire for risk stratification.
Perioperative nutrition assessment in musculoskeletal trauma patients: Dietitian evaluation is superior to serum chemistries or modified screening questionnaire for risk stratification.
复制标题
肌肉骨骼创伤患者的围手术期营养评估：营养师评估优于血清化学或改良的风险分层筛查问卷。
DOI：
10.1016/j.clnesp.2018.11.012
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发表时间：
2019
影响因子：
3
通讯作者：
Willey,MichaelC
中科院分区：
文献类型：
--
作者：
Hendrickson,NathanR;Glass,Natalie;Compton,Jocelyn;Wilkinson,BrandonG;Marsh,JLawrence;Willey,MichaelC
营养不良是一个潜在的可改变的危险因素，与骨科手术后住院费用增加、严重伤口并发症和骨折不愈合相关。本研究的目的是研究三种营养筛查工具和术后并发症的患者进行急性骨折fracture fixation.MethodsPatients年龄在18岁或以上的急性手术骨折固定在一级学术创伤中心进行筛选入院后使用营养不良筛查问卷（MSQ），并归类为低，中，高风险。由营养师对中高危患者进行临床营养不良评估。术前测量血清白蛋白、转铁蛋白、总淋巴细胞计数和25（OH）维生素D。主要结果的措施，包括12个月的术后手术和医疗并发症获得的回顾性chartreview.ResultsOf 373例，17%的中度至高度风险的营养不良MSQ。临床营养不良诊断的营养师在4.3%的患者进行了评估。近一半的受试者缺乏一种或多种血清生物标志物。生物标志物检测的成本为每位患者624美元。19%的患者发生内科或手术并发症。营养师诊断的营养不良（临床营养不良）是并发症的最强预测因子（OR 3.49，p = 0.017）。低白蛋白血症也与并发症风险增加相关（OR 1.79，p = 0.045）。MSQ评分与术后并发症无相关性。低白蛋白血症与并发症的几率增加有关，然而，与营养师评估相比，所有检测的血清化学和高相关医院费用都有很大的假阳性率。MSQ是营养不良和临床结局的不良预测因子。建议骨科创伤患者进行饮食评估。
IntroductionMalnutrition 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.MethodsPatients 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.ResultsOf 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.ConclusionsAmong 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.