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Pre-operative Hypoalbuminemia Is Associated with Complications Following Proximal Humerus Fracture Surgery: An Analysis of 919 Patients

  • Original Article
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HSS Journal ®

Abstract

Background

Proximal humerus fractures are among the most common presenting fractures to orthopedic surgeons in the USA. Hypoalbuminemia is accepted as a nutrition marker associated with post-operative complications following common orthopedic interventions.

Questions/Purposes

Thus, the authors sought to (1) describe the national demographic trends of patients undergoing surgical fixation for proximal humerus fracture and (2) investigate the association between pre-operative hypoalbuminemia, a malnutrition marker, and post-operative complications within 1 year of surgical intervention.

Methods

The PearlDiver Humana Claims Database was queried to identify a nationally representative cohort of patients who underwent surgical intervention for proximal humerus fractures from 2008 to 2015. Demographic and comorbid characteristics were collected. Pearson’s χ-squared analysis was used to compare rates of 90-day and 1-year outcomes between hypoalbuminemia (albumin ≤ 3.5 mg/dL) and control groups. Multivariate logistic regression was then used to determine the isolated effect that hypoalbuminemia had on post-operative outcomes.

Results

Of the 3337 patients identified, 919 (27.5%) had available serum albumin data. Seventy (7.6%) patients had hypoalbuminemia. Hypoalbuminemia was more likely to be associated with post-operative sepsis (7.1% vs. 1.5%, respectively) and pneumonia (15.7% vs. 4.6) compared with controls. Additionally, hypoalbuminemia was associated with increased 90-day rates of discharge to extended care (4.3% vs. 0.8), emergency room visits (38.6% vs. 21.7), and total cost ($24,051.96 ± 24,972.74 vs. $15,429.74 ± 24,492.30).

Conclusion

Our study suggests hypoalbuminemia is associated with an increased risk of complications, specifically pneumonia and sepsis, and total health care costs in patients undergoing surgery for proximal humerus fractures. These findings provide insight for individualized patient care that will aid in evaluating the potential risk of surgical complications in an effort to improve outcomes and reduce costs.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA

    Alyssa D. Althoff MD, Anthony J. Ignozzi BS, Joshua E. Bell MD & Brian C. Werner MD

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  1. Alyssa D. Althoff MD
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  2. Anthony J. Ignozzi BS
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  3. Joshua E. Bell MD
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  4. Brian C. Werner MD
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Corresponding author

Correspondence to Brian C. Werner MD.

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Conflict of Interest

Alyssa D. Althoff, MD, Anthony J. Ignozzi, BS, and Joshua Bell declare no conflict of interest. Brian C. Werner, MD, declares personal fees from Arthrex, Inc., board or committee membership from the American Orthopaedic Society for Sports Medicine and American Shoulder and Elbow Surgeons, and research support from Biomet and Integra LifeScience.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was waived from all patients for being included in this study.

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Appendix

Appendix

Table 6 Exclusion codes
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Table 7 Post-operative outcome codes
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Althoff, A.D., Ignozzi, A.J., Bell, J.E. et al. Pre-operative Hypoalbuminemia Is Associated with Complications Following Proximal Humerus Fracture Surgery: An Analysis of 919 Patients. HSS Jrnl 16 (Suppl 2), 436–442 (2020). https://doi.org/10.1007/s11420-020-09804-1

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  • DOI: https://doi.org/10.1007/s11420-020-09804-1

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