Prognostic nutritional index predicts perioperative adverse events in patients undergoing hemiarthroplasty after a hip fracture

Abstract

The relation of the prognostic nutritional index (PNI) with perioperative adverse events (PE) has never been described in hip fracture surgery patients. Therefore, this study aimed to evaluate the impact of preoperative PNI on the outcome of patients undergoing hemiarthroplasty after a hip fracture. A total of 154 adult patients aged ≥ 65 years undergoing hemiarthroplasty after a hip fracture were included in this retrospective study. The outcomes of interest were the length of stay in hospital and PE during hospitalization, defined as death, surgical site infection, major bleeding, cardiopulmonary complications, acute renal failure, pneumonia, cerebrovascular accidents, and sepsis. PNI was calculated from the following formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Patients' information, including demographic data, routine preoperative laboratory tests, and PNI, was collected to assess the association between these factors and the PE. Perioperative adverse events occurred in 21 (13.6%) of the patients. Older patients and those with more comorbid conditions such as heart failure, coronary artery disease, diabetes mellitus, cerebrovascular diseases, and chronic obstructive pulmonary diseases were tended to have a higher rate of PE. Patients with PE had lower PNI (45.2 }4.2 vs. 51.6 }5.4; p < 0.001) on admission. Multivariate analysis showed that age (OR: 2.23, 95% CI 1.15-4.45, p=0.042), presence of diabetes (OR: 2.34; 95% CI: 1.74-6.89; p =0.005) and PNI < 47.2 (OR 2.54, 95% CI 1.32-5.72, p = 0.004) were significant and independent predictors of PE. This study is the first to demonstrate that the lower preoperative PNI is associated with PE in patients undergoing hip fracture surgery.