Malnutrition Assessed Using the Geriatric Nutritional Risk Index Is Associated with Preoperative Incidence of Deep Vein Thrombosis in Japanese Patients Undergoing Total Knee Arthroplasty
Purpose: Few studies have evaluated the association between malnutrition and the risk of preoperative deep vein thrombosis (DVT) in patients undergoing primary total joint arthroplasty. This study aimed to investigate the prevalence of preoperative DVT in Japanese patients undergoing total knee arthroplasty (TKA) and the importance of malnutrition in the risk of preoperative DVT. Methods: We retrospectively analyzed 394 patients admitted for primary TKA at our institution between January 2019 and December 2023. All patients scheduled for TKA at our institution had serum D-dimer levels measured preoperatively. Lower-limb ultrasonography was examined to confirm the presence of DVT in patients with D-dimer levels ≥ 1.0 μg/mL or who were considered to be at high risk of DVT by the treating physician. Based on the results of lower-limb ultrasonography, all patients were divided into the non-DVT and DVT groups. The incidence of and risk factors for preoperative DVT were investigated, as well as the correlation of DVT with the patient’s nutritional parameters. We used two representative tools for nutritional assessment: the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status Score. Results: The mean age was 77.8 ± 6.9 years. Preoperative DVT was diagnosed in 57 of the 394 (14.5%) patients. Multivariate logistic regression analysis showed that advanced age and malnutrition status, assessed using the GNRI, were independent risk factors for preoperative DVT. Conclusion: A high incidence of preoperative DVT was observed in patients who underwent TKA. Malnutrition status, as assessed using the GNRI, increased the risk of preoperative DVT. Our findings suggest that clinicians should consider these factors when tailoring preventive strategies to mitigate DVT risk in patients undergoing TKA.
References
[1]
Lieberman, J.R. and Geerts, W.H. (1994) Prevention of Venous Thromboembolism after Total Hip and Knee Arthroplasty. The Journal of Bone & Joint Surgery, 76, 1239-1250. https://doi.org/10.2106/00004623-199408000-00015
[2]
Falck-Ytter, Y., Francis, C.W., Johanson, N.A., Curley, C., Dahl, O.E., Schulman, S., et al. (2012) Prevention of VTE in Orthopedic Surgery Patients. Chest, 141, e278S-e325S. https://doi.org/10.1378/chest.11-2404
[3]
Memtsoudis, S.G., González Della Valle, A., Besculides, M.C., Esposito, M., Koulouvaris, P. and Salvati, E.A. (2010) Risk Factors for Perioperative Mortality after Lower Extremity Arthroplasty: A Population-Based Study of 6,901,324 Patient Discharges. The Journal of Arthroplasty, 25, 19-26. https://doi.org/10.1016/j.arth.2008.11.010
[4]
Pedersen, A.B., Sorensen, H.T., Mehnert, F., Overgaard, S. and Johnsen, S.P. (2010) Risk Factors for Venous Thromboembolism in Patients Undergoing Total Hip Replacement and Receiving Routine Thromboprophylaxis. The Journal of Bone and Joint Surgery-American Volume, 92, 2156-2164. https://doi.org/10.2106/jbjs.i.00882
[5]
JCS Joint Working Group, (2011) Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism and Deep Vein Thrombosis (JCS 2009). Circulation Journal, 75, 1258-1281. https://doi.org/10.1253/circj.cj-88-0010
[6]
Jia, Z., El Moheb, M., Nordestgaard, A., Lee, J.M., Meier, K., Kongkaewpaisan, N., et al. (2020) The Geriatric Nutritional Risk Index Is a Powerful Predictor of Adverse Outcome in the Elderly Emergency Surgery Patient. Journal of Trauma and Acute Care Surgery, 89, 397-404. https://doi.org/10.1097/ta.0000000000002741
[7]
Bohl, D.D., Shen, M.R., Kayupov, E., Cvetanovich, G.L. and Della Valle, C.J. (2016) 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. The Journal of Arthroplasty, 31, 963-967. https://doi.org/10.1016/j.arth.2015.11.025
[8]
Fang, C.J., Saadat, G.H., Butler, B.A. and Bokhari, F. (2022) The Geriatric Nutritional Risk Index Is an Independent Predictor of Adverse Outcomes for Total Joint Arthroplasty Patients. The Journal of Arthroplasty, 37, S836-S841. https://doi.org/10.1016/j.arth.2022.01.049
[9]
Cross, M.B., Yi, P.H., Thomas, C.F., Garcia, J. and Della Valle, C.J. (2014) Evaluation of Malnutrition in Orthopaedic Surgery. Journal of the American Academy of Orthopaedic Surgeons, 22, 193-199. https://doi.org/10.5435/jaaos-22-03-193
de van der Schueren, M.A.E. and Jager-Wittenaar, H. (2022) Malnutrition Risk Screening: New Insights in a New Era. Clinical Nutrition, 41, 2163-2168. https://doi.org/10.1016/j.clnu.2022.08.007
[12]
Zhang, X., Zhang, Z., Zhu, Y., Tao, J., Zhang, Y., Wang, Y., et al. (2020) Comparison of the Efficacy of Nutritional Risk Screening 2002 and Mini Nutritional Assessment Short Form in Recognizing Sarcopenia and Predicting Its Mortality. European Journal of Clinical Nutrition, 74, 1029-1037. https://doi.org/10.1038/s41430-020-0621-8
[13]
Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, González P, González B, Mancha A, et al (2005) CONUT: A Tool for Controlling Nutritional Status. First Validation in a Hospital Population. NutriciónHospitalaria, 20, 38-45.
[14]
Bouillanne, O., Morineau, G., Dupont, C., Coulombel, I., Vincent, J., Nicolis, I., et al. (2005) Geriatric Nutritional Risk Index: A New Index for Evaluating At-Risk Elderly Medical Patients. The American Journal of Clinical Nutrition, 82, 777-783. https://doi.org/10.1093/ajcn/82.4.777
[15]
Kain, Z.N., Vakharia, S., Garson, L., Engwall, S., Schwarzkopf, R., Gupta, R., et al. (2014) The Perioperative Surgical Home as a Future Perioperative Practice Model. Anesthesia & Analgesia, 118, 1126-1130. https://doi.org/10.1213/ane.0000000000000190
[16]
Kaneko, T., Nakamura, S., Hayakawa, K., Tokimura, F. and Miyazaki, T. (2023) Preoperative Incidence and Risk Factors of Deep Vein Thrombosis in Japanese Patients Undergoing Total Hip Arthroplasty. European Journal of Orthopaedic Surgery & Traumatology, 33, 2859-2864. https://doi.org/10.1007/s00590-023-03508-y
[17]
Sato, K., Date, H., Michikawa, T., Morita, M., Hayakawa, K., Kaneko, S., et al. (2021) Preoperative Prevalence of Deep Vein Thrombosis in Patients Scheduled to Have Surgery for Degenerative Musculoskeletal Disorders. BMC Musculoskeletal Disorders, 22, Article No. 513. https://doi.org/10.1186/s12891-021-04405-3
[18]
Xiong, X. and Cheng, B. (2023) Preoperative Risk Factors for Deep Vein Thrombosis in Knee Osteoarthritis Patients Undergoing Total Knee Arthroplasty. Journal of Orthopaedic Science, 28, 180-187. https://doi.org/10.1016/j.jos.2021.09.016
[19]
Wakabayashi, H., Hasegawa, M., Niimi, R., Yamaguchi, T., Naito, Y. and Sudo, A. (2017) The Risk Factor of Preoperative Deep Vein Thrombosis in Patients Undergoing Total Knee Arthroplasty. Journal of Orthopaedic Science, 22, 698-702. https://doi.org/10.1016/j.jos.2017.04.007
[20]
Sun, W., Ai, D., Yao, Y., Ren, K., Lu, J., Sun, H., et al. (2022) The Application of Caprini Risk Assessment Model in Evaluation of Deep Vein Thrombosis for Patients with End-Stage Osteoarthritis before Arthroplasty. BMC Musculoskeletal Disorders, 23, Article No. 767. https://doi.org/10.1186/s12891-022-05712-z
[21]
Doweiko, J.P. and Nompleggi, D.J. (1991) Reviews: The Role of Albumin in Human Physiology and Pathophysiology, Part III: Albumin and Disease States. Journal of Parenteral and Enteral Nutrition, 15, 476-483. https://doi.org/10.1177/0148607191015004476
[22]
Kuzuya, M., Izawa, S., Enoki, H., Okada, K. and Iguchi, A. (2007) Is Serum Albumin a Good Marker for Malnutrition in the Physically Impaired Elderly? Clinical Nutrition, 26, 84-90. https://doi.org/10.1016/j.clnu.2006.07.009
[23]
Kregel, H.R., Murphy, P.B., Attia, M., Meyer, D.E., Morris, R.S., Onyema, E.C., et al. (2022) The Geriatric Nutritional Risk Index as a Predictor of Complications in Geriatric Trauma Patients. Journal of Trauma and Acute Care Surgery, 93, 195-199. https://doi.org/10.1097/ta.0000000000003588
[24]
Nanri, Y., Shibuya, M., Fukushima, K., Uchiyama, K., Takahira, N. and Takaso, M. (2021) Preoperative Malnutrition Is a Risk Factor for Delayed Recovery of Mobilization after Total Hip Arthroplasty. PM&R, 13, 1331-1339. https://doi.org/10.1002/pmrj.12570
[25]
Shiroma, K., Tanabe, H., Takiguchi, Y., Yamaguchi, M., Sato, M., Saito, H., et al. (2023) A Nutritional Assessment Tool, GNRI, Predicts Sarcopenia and Its Components in Type 2 Diabetes Mellitus: A Japanese Cross-Sectional Study. Frontiers in Nutrition, 10, Article 1087471. https://doi.org/10.3389/fnut.2023.1087471
[26]
Zhao, Y., Lin, T., Hou, L., Zhang, M., Peng, X., Xie, D., et al. (2021) Association between Geriatric Nutritional Risk Index and Frailty in Older Hospitalized Patients. Clinical Interventions in Aging, 16, 1241-1249. https://doi.org/10.2147/cia.s313827
[27]
Cereda, E. and Vanotti, A. (2007) The New Geriatric Nutritional Risk Index Is a Good Predictor of Muscle Dysfunction in Institutionalized Older Patients. Clinical Nutrition, 26, 78-83. https://doi.org/10.1016/j.clnu.2006.09.007
[28]
Xiang, Q., Li, Y., Xia, X., Deng, C., Wu, X., Hou, L., et al. (2022) Associations of Geriatric Nutrition Risk Index and Other Nutritional Risk-Related Indexes with Sarcopenia Presence and Their Value in Sarcopenia Diagnosis. BMC Geriatrics, 22, Article No. 327. https://doi.org/10.1186/s12877-022-03036-0
[29]
Shin, J., Hong, S., Choi, K., Shin, S., Lee, D.K., Lee, S., et al. (2019) Low Relative Muscle Volume: Correlation with Prevalence of Venous Thromboembolism Following Total Knee Arthroplasty. PLOS ONE, 14, e0210800. https://doi.org/10.1371/journal.pone.0210800