Preoperative nutritional status and its association with postoperative complications and survival in patients undergoing total hip arthroplasty: a retrospective cohort analysis

Abstract

Adverse preoperative nutritional indicators are common among patients undergoing hip arthroplasty and have been associated with poorer surgical outcomes. However, evidence simultaneously evaluating multiple preoperative nutritional measures in relation to short-term postoperative complications and longer-term survival in patients undergoing total hip arthroplasty remains limited. To evaluate the associations of preoperative nutritional status, assessed using the Prognostic Nutritional Index (PNI), serum albumin, and Nutritional Risk Screening 2002 (NRS-2002), with 30-day postoperative complications and overall survival in patients undergoing total hip arthroplasty (THA). This single-center retrospective cohort study enrolled 426 consecutive patients who underwent primary THA between January 2020 and December 2023 at a tertiary academic medical center. Patients were stratified into three preoperative PNI strata: PNI ≥ 45 ( n  = 198), PNI 40–44.9 ( n  = 142), and PNI < 40 ( n  = 86). The primary outcomes were 30-day postoperative complications and estimated 3-year overall survival. Logistic regression and Cox proportional hazards models were used to explore adjusted associations. The overall 30-day complication rate was 18.3% (78/426). Patients with PNI < 40 had a significantly higher complication rate (34.9%) than those with PNI 40–44.9 (19.0%) and PNI ≥ 45 (10.6%; p  < 0.001). In the reported adjusted model, PNI < 40 (OR = 3.42, 95% CI: 2.01–5.82; p  < 0.001), serum albumin < 35 g/L (OR = 2.64, 95% CI: 1.58–4.41; p  < 0.001), and NRS-2002 score ≥ 3 (OR = 2.21, 95% CI: 1.35–3.62; p  = 0.002) were associated with higher odds of postoperative complications. The estimated 3-year overall survival probabilities were 93.4, 82.4, and 68.6% for the PNI ≥ 45, PNI 40–44.9, and PNI < 40 strata, respectively (log-rank p  < 0.001). In the reported Cox model, PNI < 40 was associated with higher mortality (HR = 2.96, 95% CI: 1.78–4.92; p  < 0.001). Lower preoperative PNI, hypoalbuminemia, and NRS-2002-defined nutritional risk were associated with higher postoperative complication risk and lower estimated long-term survival after THA. These measures may assist preoperative risk stratification. Prospective studies are required to determine whether nutritional interventions modify postoperative complications or survival.