BACKGROUND: Total hip arthroplasty (THA) provides pain relief and restored mobility, yet recovery remains challenging for underweight patients whose nutritional deficits may compromise outcomes. This study examined the impact of low body mass index (BMI) and hypoalbuminemia on postoperative complications following THA.
METHODS: Using a national surgical database (2012 to 2021), patients who underwent primary THA (Current Procedural Terminology 27130) with a BMI less than 25 were analyzed. Patients were categorized as Underweight (BMI less than 18.5) or Normal weight (BMI 18.5 to 24.99) and further stratified by albumin level (hypoalbuminemic less than 3.5 g/dL; normoalbuminemic 3.5 to 5.5 g/dL). Among 64,856 patients, 2,948 (4.5%) were Underweight and 61,908 (95.5%) were Normal weight. Multivariate logistic regression models adjusted for demographics and comorbidities evaluated 30-day postoperative complications.
RESULTS: Underweight patients had higher risks of postoperative bleeding (odds ratio [OR] 1.54, P < 0.001), cardiac arrest (OR 2.47, P < 0.01), readmission (OR 1.21, P < 0.05), and death (OR 2.98, P < 0.001). In hypoalbuminemic patients (n = 337 Underweight), bleeding risk increased (OR 1.38, P < 0.05). Combined low BMI and hypoalbuminemia markedly elevated risks of bleeding (OR 3.01, P < 0.001), cardiac arrest (OR 4.74, P < 0.05), urinary tract infection (OR 2.36, P < 0.01), readmission (OR 1.94, P < 0.001), and death (OR 7.09, P < 0.001) versus Normal weight normoalbuminemic patients.
CONCLUSION: Underweight status and malnutrition are associated with higher complication risks after THA, with hypoalbuminemia amplifying adverse outcomes. The increased rates of bleeding, cardiac arrest, and mortality highlight the physiological vulnerability of nutritionally depleted patients. Incorporating BMI and albumin assessment into preoperative optimization protocols may identify at-risk patients and guide nutritional interventions to improve outcomes after THA.
Read the article: PubMed · Publisher (DOI)