The geriatric nutritional risk index as a prognostic factor in revision total knee arthroplasty: A retrospective cohort study

The geriatric nutritional risk index as a prognostic factor in revision total knee arthroplasty: A retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The geriatric nutritional risk index as a prognostic factor in revision total knee arthroplasty: A retrospective cohort study Steven H. Liu, Brandon Lung, Jane Burgan, Rachel A. Loyst, James J. Nicholson, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3892380/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a readily available index measuring the risk of malnutrition, and 30-day postoperative complications following revision total knee arthroplasty (rTKA). Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients ≥ 65 who underwent rTKA between 2015 and 2021. The study population was divided into three groups based on preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92). Multivariate logistic regression analysis was conducted to investigate the association between preoperative GNRI and postoperative complications. Results Compared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, blood transfusions, surgical site infection (SSI), non-home discharge, readmission, length of stay (LOS) > 2 days, and mortality. Severe malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, septic shock, pneumonia, unplanned reintubation, cardiac arrest or myocardial infarction, stroke, blood transfusions, still on ventilator > 48 hours, SSI, wound dehiscence, acute renal failure, non-home discharge, readmission, unplanned reoperation, LOS > 2 days, and mortality. Severe malnutrition was independently significantly associated with a greater number of complications and had a stronger association with complications compared to moderate malnutrition. Conclusion Malnutrition identified by GNRI has strong predictive value for short-term postoperative complications following rTKA in geriatric patients and may have utility as an adjunctive risk stratification tool for geriatric patients undergoing rTKA. knee revision total knee arthroplasty malnutrition geriatric geriatric nutritional risk index complications postoperative Figures Figure 1 Introduction Total knee arthroplasty (TKA) is an effective surgical treatment option for patients with debilitating knee osteoarthritis (OA) seeking to alleviate pain and improve quality of life.[ 1 , 2 ] Osteoarthritis is the most prevalent joint disease in the United States, with knee OA accounting for 80% of the disease’s total burden.[ 3 ] The geriatric population is rapidly growing in the United States, resulting in more adults suffering from OA and thus a greater prevalence of TKA.[ 4 , 5 ] Revision total knee arthroplasty (rTKA) procedures, which are often performed to correct complications following primary TKA, such as prosthetic infections and joint loosening, are also increasing as more TKAs are being performed.[ 6 ] The incidence of both TKA and rTKA is expected to rise, with a projected 90% annual increase in rTKA compared to a 43% annual increase in TKA.[ 7 ] With a rising incidence of rTKAs, it has become increasingly pertinent to understand patient risk factors and conditions associated with poorer postoperative outcomes. Malnutrition is a well-documented risk factor in orthopedic joint surgery that has been linked to an increased rate of adverse postoperative outcomes, including infection, myocardial infarction, increased length of hospital stay, readmission, and return visits to the emergency department.[ 8 – 11 ] In the past, serum albumin has been used as a marker for malnutrition. However, due to mixed evidence regarding its validity as a proxy for malnutrition, newer risk indices such as the Geriatric Nutritional Risk Index (GNRI) have been developed.[ 12 ] GNRI, which assesses the risk of malnutrition in geriatric patients, is calculated using serum albumin and ideal body weight.[ 13 ] Previous literature has demonstrated that GNRI is a predictor of adverse postoperative outcomes following total joint arthroplasty (TJA).[ 14 ] However, its utility in assessing the prognosis of geriatric patients who undergo rTKA has not been studied. The purpose of this study is to investigate the relationship between GNRI and postoperative outcomes following rTKA. We hypothesized that there is an increased risk of early postoperative complications in patients with GNRI indicative of malnutrition compared to patients with normal GNRI. Materials and Methods We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for all patients who underwent rTKA between 2015 and 2021. This study was exempt from approval by our University’s Institutional Review Board because the NSQIP database is fully de-identified. Data in the NSQIP database is obtained from over 600 hospitals in the United States, is collected by trained Surgical Clinical Reviewers, and provides validates 30-day surgical outcomes. The Current Procedural Terminology (CPT) codes corresponding to rTKA (27486—one component and 27487—femoral and entire tibial component) were used to identify 30,557 patients who underwent rTKA between 2015 and 2021. NSQIP inherently excludes all cases of patients under 18 years of age and all cases with primary admission criteria related to trauma. Revisions secondary to periprosthetic joint infections were excluded because the NSQIP does not provide information related to the chronicity of the infection (acute vs. chronic) or the type of revision (one- or two-stage procedure). Thus, cases with the removal of a prosthesis with or without the insertion of a spacer (CPT code 27488), and either sepsis or septic shock at the time of the operation were not included in the study. 13,038 patients with missing height, weight, or preoperative albumin values required to calculate GNRI were excluded, leaving 17,519 patients. Next, 8,110 cases were excluded for missing American Society of Anesthesiologists (ASA) classification, unknown discharges destination, functional health status, age < 65, or underwent rTKA due to an infectious cause. GNRI was then calculated for each patient using the following formula, using weight (lb) and albumin (g/L):[ 14 – 16 ] $$GNRI=\left(1.489*Albumin\right)+\left(41.7*\frac{Weight}{WLo}\right)$$ WLo is the ideal weight, calculated separately for male and female gender using the Lorentz equations, using height (cm):[ 14 – 16 ] \({WLo}_{male}=\left(Height-100\right)+\frac{Height-150}{4}\) $${WLo}_{female}=\left(Height-100\right)-\frac{Height-150}{2.5}$$ To not miss overweight or obese patients with malnutrition, the ratio of Weight/WLo was capped at 1 if weight exceeded WLo.[ 14 , 15 ] The remaining study population (Fig. 1 ) was then indexed into three cohorts based on their preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92). These validated cutoffs were chosen based on preexisting research on GNRI in TJA.[ 14 ] Variables collected in this study included patient demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data. Patient demographics included gender, body mass index (BMI), age, smoking status, functional status, ASA classification, and preoperative steroid use. Steroid use status was defined as patients who routinely used immunosuppressants or corticosteroids within 30 days pre-procedure. Smoking status was defined as cigarette use at any point within the past year before the procedure. Preoperative comorbidities included congestive heart failure (CHF), diabetes, hypertension, severe chronic obstructive pulmonary disease (COPD), bleeding disorders, and disseminated cancer. 30-day complications included the following: sepsis, septic shock, pneumonia, unplanned reintubation, urinary tract infection (UTI), cardiac arrest or myocardial infarction (MI), stroke, blood transfusions, deep vein thrombosis (DVT), pulmonary embolism (PE), on ventilator > 48 hours, surgical space infection (SSI), wound dehiscence, acute renal failure, Clostridioides difficile ( C. diff ) infection, non-home discharge, readmission, unplanned reoperation, length of stay (LOS) > 2 days, mortality. All statistical analyses were conducted using SPSS Software version 26.0 (IBM Corp., Armonk, NY, USA). Patient demographics and comorbidities were compared between cohorts using bivariate logistic regression. Multivariate logistic regression, adjusted for all significantly associated patient demographics and comorbidities for the respective cohort, was used to identify associations between preoperative GNRI and postoperative complications. Odds ratios (OR) were reported with 95% confidence intervals (CI). The level of statistical significance was set at p < 0.05. Results Compared to the normal nutrition group, the moderate malnutrition group was statistically significant for older age groups (p < 0.001), abnormal BMI groups (p < 0.001) dependent functional status (p < 0.001), ASA classification ≥ 3 (p < 0.001), smoker (p = 0.017), chronic steroid use (p < 0.001), and comorbid CHF (p < 0.001), diabetes (p = 0.005), hypertension (p = 0.003), COPD (p < 0.001), bleeding disorders (p < 0.001) (Table 1 ). Compared to the normal nutrition group, the severe malnutrition group was statistically significant for older age groups (p < 0.001), dependent functional status (p < 0.001), ASA classification ≥ 3 (p < 0.001), chronic steroid use (p < 0.001), and comorbid CHF (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.001), COPD (p < 0.001), bleeding disorders (p < 0.001), and disseminated cancer (p 98) Moderate malnutrition (92 ≤ GNRI ≤ 98) Severe malnutrition (GNRI < 92) Number (%) Number (%) p value Number (%) p value Overall 6,658 (100.0) 1,636 (100.0) 1,115 (100.0) Sex 0.243 0.747 Female 3,850 (57.8) 972 (59.4) 639 (57.3) Male 2,808 (42.2) 664 (40.6) 476 (42.7) Age < 0.001 < 0.001 65–74 4,481 (67.3) 955 (58.4) 554 (49.7) 75–84 1,907 (28.6) 557 (34.0) 402 (36.1) ≥ 85 270 (4.1) 124 (7.6) 159 (14.3) BMI (kg/m^2) < 0.001 0.413 < 18.5 19 (0.3) 12 (0.7) 7 (0.6) 18.5–29.9 2,569 (38.6) 551 (33.7) 456 (40.9) 30-34.9 1,979 (29.7) 452 (27.6) 285 (25.6) 35-39.9 1,288 (19.3) 355 (21.7) 185 (16.6) ≥ 40 803 (12.1) 266 (16.3) 182 (16.3) Functional status prior to surgery < 0.001 < 0.001 Dependent 191 (2.9) 128 (7.8) 156 (14.0) Independent 6,467 (97.1) 1,508 (92.2) 959 (86.0) ASA classification < 0.001 < 0.001 ≤ 2 2,271 (34.1) 387 (23.7) 131 (11.7) ≥ 3 4,387 (65.9) 1,249 (76.3) 984 (88.3) Smoker 0.017 0.300 No 6,364 (95.6) 1,541 (94.2) 1,058 (94.9) Yes 294 (4.4) 95 (5.8) 57 (5.1) Steroid use < 0.001 < 0.001 No 6,357 (95.5) 1,526 (93.3) 1,015 (91.0) Yes 301 (4.5) 110 (6.7) 100 (9.0) Comorbidities CHF 89 (1.3) 47 (2.9) < 0.001 75 (6.7) < 0.001 Diabetes 1,486 (22.3) 419 (25.6) 0.005 309 (27.7) < 0.001 Hypertension 4,979 (74.8) 1,282 (78.4) 0.003 889 (79.7) < 0.001 COPD 323 (4.9) 120 (7.3) < 0.001 113 (10.1) < 0.001 Bleeding Disorder 253 (3.8) 107 (6.5) < 0.001 150 (13.5) < 0.001 Disseminated Cancer 14 (0.2) 7 (0.4) 0.124 26 (2.3) < 0.001 Total operation time (minutes) 0.817 0.066 0–79 1,291 (19.4) 310 (18.9) 240 (21.5) 80–128 2,049 (30.8) 526 (32.2) 347 (31.1) ≥ 129 3,318 (49.8) 800 (48.9) 528 (47.4) GNRI, Geriatric Nutritional Risk Index; BMI, body mass index; ASA, American Society of Anesthesiologists; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease Compared to the normal nutrition group, the moderate malnutrition group was significantly associated with a greater likelihood of experiencing any complication (p < 0.001), pneumonia (p = 0.017), blood transfusions (p < 0.001), SSI (p < 0.001), wound dehiscence (p = 0.041), non-home discharge (p < 0.001), readmission (p 2 days (p < 0.001), and mortality (p < 0.001) (Table 2 ). Compared to the normal nutrition group, the severe malnutrition group was significantly associated with a greater likelihood of experiencing any complication (p < 0.001), septic shock (p < 0.001), pneumonia (p < 0.001), unplanned reintubation (p < 0.001), cardiac arrest or MI (p < 0.001), stroke (p < 0.001), blood transfusions (p 48 hours (p < 0.001), SSI (p < 0.001), wound dehiscence (p < 0.001), acute renal failure (p < 0.001), C. diff infection (p < 0.001), non-home discharge (p < 0.001), readmission (p 2 days (p < 0.001), and mortality (p 98) Moderate malnutrition (92 ≤ GNRI ≤ 98) Severe malnutrition (GNRI < 92) Number (%) Number (%) p value Number (%) p value Any complication 3,139 (47.1) 1,058 (64.7) < 0.001 980 (87.9) < 0.001 Sepsis 27 (0.4) 9 (0.6) 0.427 9 (0.8) 0.073 Septic shock 6 (0.1) 3 (0.2) 0.315 9 (0.8) < 0.001 Pneumonia 18 (0.3) 11 (0.7) 0.017 24 (2.2) < 0.001 Unplanned reintubation 15 (0.2) 4 (0.2) 0.884 14 (1.3) < 0.001 UTI 53 (0.8) 13 (0.8) 0.995 14 (1.3) 0.128 Cardiac arrest or MI 26 (0.4) 10 (0.6) 0.228 19 (1.7) < 0.001 Stroke 8 (0.1) 1 (0.1) 0.524 8 (0.7) < 0.001 Blood transfusions 323 (4.9) 208 (12.7) < 0.001 252 (22.6) 48 hours 4 (0.1) 3 (0.2) 0.144 11 (1.0) < 0.001 SSI 162 (2.4) 76 (4.6) < 0.001 78 (7.0) < 0.001 Wound dehiscence 47 (0.7) 4 (0.2) 0.041 21 (1.9) < 0.001 Acute renal failure 5 (0.1) 1 (0.1) 0.851 6 (0.5) < 0.001 Clostridioides difficile infection 13 (0.2) 5 (0.3) 0.394 8 (0.7) < 0.001 Non-home discharge 1,392 (20.9) 606 (37.0) < 0.001 585 (52.5) < 0.001 Readmission 341 (5.1) 125 (7.6) < 0.001 124 (11.1) 2 days 2,695 (40.5) 965 (59.0) < 0.001 925 (83.0) < 0.001 Periprostatic fracture 24 (0.4) 6 (0.4) 0.97 4 (0.4) 0.993 Mortality 11 (0.2) 12 (0.7) < 0.001 24 (2.2) < 0.001 GNRI, Geriatric Nutritional Risk Index; UTI, urinary tract infection; MI, myocardial infarction; DVT, deep vein thrombosis; PE, pulmonary embolism; SSI, surgical space infection After controlling for all significant patient demographic and comorbidity factors, an adjusted multivariate regression analysis was conducted (Table 3 ). Compared to the normal nutrition group, the moderate malnutrition group was independently significantly associated with a greater likelihood of experiencing any complications (OR 1.74, 95% CI 1.55–1.95; p < 0.001), blood transfusions (OR 2.33, 95% CI 1.92–2.82; p < 0.001), SSI (OR 1.74, 95% CI 1.31–2.32; p < 0.001), non-home discharge (OR 1.82, 95% CI 1.61–2.06; p 2 days (OR 1.83, 95% CI 1.63–2.04; p < 0.001), and mortality (OR 2.83, 95% CI 1.22–6.60; p = 0.016). Compared to the normal nutritional group, the severe malnutrition group was independently significantly associated with a greater likelihood of experiencing any complication (OR 5.92, 95% CI 4.89–7.17; p < 0.001), septic shock (OR 7.62, 95% CI 2.57–22.61; p < 0.001), pneumonia (OR 4.93, 95% CI 2.53–9.62; p < 0.001), unplanned reintubation (OR 3.93, 95% CI 1.79–8.61; p < 0.001), cardiac arrest or MI (OR 3.29, 95% CI 1.73–6.27; p < 0.001), stroke (OR 5.13, 95% CI 1.75-15.00; p = 0.003), blood transfusions (OR 3.85, 95% CI 3.16–4.68; p 48 hours (OR 5.93, 95% CI 1.89–18.59; p = 0.002), SSI (OR 2.61, 95% CI 1.93–3.52; p < 0.001), wound dehiscence (OR 2.39, 95% CI 1.37–4.16; p = 0.002), acute renal failure (OR 4.84, 95% CI 1.27–18.53; p = 0.021), non-home discharge (OR 2.87, 95% CI 2.49–3.32; p < 0.001), readmission (OR 1.89, 95% CI 1.49–2.39; p 2 days (OR 5.45, 95% CI 4.60–6.46; p < 0.001), and mortality (OR 6.95, 95% CI 3.23–14.93; p < 0.001). Table 3 Multivariate analysis of postoperative complications in patients with normal GNRI, moderate malnutrition, and severe malnutrition. Moderate malnutrition (92 ≤ GNRI ≤ 98) Severe malnutrition (GNRI < 92) OR, p value (95% CI) OR, p value (95% CI) Any complication 1.74, < 0.001 (1.55–1.95) 5.92, < 0.001 (4.89–7.17) Septic shock -- 7.62, < 0.001 (2.57–22.61) Pneumonia 1.69, 0.184 (0.78–3.67) 4.93, < 0.001 (2.53–9.62) Unplanned reintubation -- 3.93, < 0.001 (1.79–8.61) Cardiac arrest or MI -- 3.29, < 0.001 (1.73–6.27) Stroke 0.51, 0.525 (0.06–4.09) 5.13, 0.003 (1.75-15.00) Blood transfusions 2.33, < 0.001 (1.92–2.82) 3.85, 48 hours -- 5.93, 0.002 (1.89–18.59) SSI 1.74, < 0.001 (1.31–2.32) 2.61, < 0.001 (1.93–3.52) Wound dehiscence -- 2.39, 0.002 (1.37–4.16) Acute renal failure -- 4.84, 0.021 (1.27–18.53) Clostridioides difficile infection -- 2.08, 0.149 (0.77–5.64) Non-home discharge 1.82, < 0.001 (1.61–2.06) 2.87, < 0.001 (2.49–3.32) Readmission 1.32, 0.011 (1.07–1.65) 1.89, 2 days 1.83, < 0.001 (1.63–2.04) 5.45, < 0.001 (4.60–6.46) Mortality 2.83, 0.016 (1.22–6.60) 6.95, < 0.001 (3.23–14.93) GNRI, Geriatric Nutritional Risk Index; OR, odds ratio; CI, confidence interval; MI, myocardial infarction; SSI, surgical space infection In general, compared to the normal nutrition group, severe malnutrition was independently significantly associated with a greater number of complications than moderate malnutrition. Moreover, for complications independently significantly associated with both moderate and severe malnutrition, severe malnutrition was generally found to have stronger associations: any complication (OR 1.74 in moderate malnutrition vs. 5.92 in severe malnutrition), blood transfusions (OR 2.33 vs. 3.85), SSI (OR 1.74 vs. 2.61), non-home discharge (OR 1.82 vs 2.87), readmission (OR 1.32 vs. 1.89), LOS > 2 days (OR 1.83 vs. 5.45), and mortality (OR 2.83 vs. 6.95). Discussion In this study, we found that compared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, blood transfusions, SSI, non-home discharge, readmission, LOS > 2 days, and mortality. Severe malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, septic shock, pneumonia, unplanned reintubation, cardiac arrest or myocardial infarction, stroke, blood transfusions, on ventilator > 48 hours, SSI, wound dehiscence, acute renal failure, non-home discharge, readmission, unplanned reoperation, LOS > 2 days, and mortality. Severe malnutrition was independently significantly associated with a greater number of complications and had a stronger association with complications compared to moderate malnutrition. Malnutrition was recently defined by the European Society of Clinical Nutrition and Metabolism as “BMI 10% of initial body weight with BMI < 20 kg/m 2 if < 70 years of age or BMI < 22 kg/m 2 if older than 70 years, or fat-free mass index < 15 and 17 kg/m 2 in women and men respectively.”[ 17 ] While this definition has been widely used, there exist critics who advocate for the consideration of measures reflecting bodily function such as inflammation.[ 18 ] It has been well established that malnutrition downregulates the immune response by suppressing immunologic functions such as lymphocyte production and antibody secretion.[ 19 – 21 ] These processes may be especially detrimental in post-operative patients who need a robust immune response to repair wounds, prevent catabolic states, and fight off infections.[ 22 ] Our analysis found that both moderate and severe malnutrition were commonly significantly associated with an older demographic, dependent functional status, ASA classification ≥ 3, steroid use, CHF, diabetes, hypertension, COPD, and bleeding disorder. One study investigating the albumin-to-fibrinogen ratio as a proxy for malnutrition also found that diabetes and an ASA classification ≥ 3 were significantly associated with malnourished patients.[ 23 ] Another study reviewing the relationship between hypoalbuminemia and TJA found that malnourished patients had significant associations with dependent functional status, steroid use, smoking, and multiple comorbidities.[ 24 ] Moreover, CHF, bleeding disorders, and metastatic cancer have been documented as significantly associated demographics in malnourished patients who receive TJA.[ 25 ] Thus, our findings support preexisting literature showing that malnourished patients have a greater number of comorbidities compared to patients with normal nutrition. We found both moderate and severe malnutrition to be significantly associated with an increased likelihood of experiencing any postoperative complication. The moderate malnutrition group was independently significantly associated with blood transfusions, SSI, non-home discharge, readmission, LOS > 2 days, and mortality, while the severe malnutrition group was independently significantly associated with septic shock, pneumonia, unplanned reintubation, cardiac arrest or MI, stroke, blood transfusions, on ventilator > 48 hours, SSI, wound dehiscence, acute renal failure, non-home discharge, readmission, unplanned reoperation, LOS > 2 days, and mortality. Our findings support existing literature showing that malnutrition is linked to infections and wound complications following rTKA.[ 10 , 26 ] Furthermore, our results demonstrate that similar to malnourished patients who undergo TJA, malnourished patients who undergo rTKA are more likely to experience poorer outcomes postoperatively.[ 11 , 26 – 28 ] As the average age of patients who undergo rTHA increases[ 4 ], methods for quantifying nutritional status must be sufficiently robust to differentiate between normal changes with age versus changes due to poor nutrition. GNRI was developed to quantify the risk of malnutrition in older adults as an alternative to hypoalbuminemia and BMI, which have been criticized for their one-dimensionality and inability to consider the systemic processes related to malnutrition.[ 18 ] In our study, only 0.7% and 0.6% of moderately and severely malnourished patients respectively had BMI < 18.5, showing that the utility of BMI in determining nutrition status is limited in isolation. However, GNRI combines features of body weight and serum albumin, using body weight to modulate the degree of albumin discrepancy required for malnourished classification. That is, patients with ideal body weight require a greater albumin abnormality to be considered malnourished based on GNRI compared to patients with lower than ideal body weight. While other malnutrition indices such as the Mini Nutritional Assessment (MNA) exist, GNRI has proven to have the most clinical utility, demonstrating better sensitivity in predicting three- and six-month mortality rates as well as better specificity and diagnostic power compared to MNA.[ 2 , 29 , 30 ] Furthermore, GNRI is a simple and efficient means of diagnosing malnutrition—only requiring height, weight, and albumin levels—and has the added benefit of not requiring a caregiver to be present.[ 30 ] For these reasons, the incorporation of GNRI as an adjuvant screening tool for malnutrition in geriatric patients undergoing rTKA should be considered. There exist limitations in our study due to the characteristics of the NSQIP database. We were limited to short-term, 30-day postoperative outcomes, limiting our ability to draw conclusions regarding GNRI as a predictor of long-term adverse outcomes. Additionally, we excluded a proportion of patients from our initial query due to missing height, weight, and albumin. Serum albumin is not routinely collected preoperatively if a patient is clinically low risk. Therefore, there may exist some degree of selection bias in our study. Furthermore, the database does not report information related to management, including pre- or postoperative nutritional supplementation that holds the ability to impact outcomes. To our knowledge, this is the first study to investigate the association between GNRI and postoperative outcomes following rTKA. Our study contributes to the current findings of malnutrition in orthopedic surgeries, focusing on the growing population of older adults undergoing rTKA to better understand how to improve patient perioperative and postoperative treatment plans based on their risk factors. Conclusion In geriatric patients with GNRI indicative of malnutrition, the overall rate of complication following rTKA was found to increase with increasing severity of malnutrition. Compared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, blood transfusions, SSI, non-home discharge, readmission, LOS > 2 days, and mortality. Severe malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, septic shock, pneumonia, unplanned reintubation, cardiac arrest or MI, stroke, blood transfusions, on ventilator > 48 hours, SSI, wound dehiscence, acute renal failure, non-home discharge, readmission, unplanned reoperation, LOS > 2 days, and mortality. Our results show that GNRI is a strong predictor of early postoperative complications for geriatric rTKA patients and support its utility as an adjunctive risk stratification tool for geriatric patients undergoing rTKA. Declarations Ethics approval and consent to participate The University of California Irvine Institutional Review Board deemed this study IRB exempt given that this study was retrospective, and the data studied was already de-identified and publicly available. Consent for publication Not Applicable. Availability of data and materials The datasets analyzed during the current study are available in the NSQIP repository, https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/. Competing interests The authors declare no competing interests. Funding The authors of this manuscript have no funding sources to disclose. Authors’ contributions SL and RL compiled the data for this manuscript. SL, BL, RL, and JB ran the data and constructed the manuscript. 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Nutrients 2021, 13 (8):2764. Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA: Current Epidemiology of Revision Total Knee Arthroplasty in the United States . The Journal of Arthroplasty 2017, 32 (9):2663-2668. Klug A, Gramlich Y, Rudert M, Drees P, Hoffmann R, Weißenberger M, Kutzner KP: The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years . Knee Surgery, Sports Traumatology, Arthroscopy 2021, 29 (10):3287-3298. Kishawi D, Schwarzman G, Mejia A, Hussain AK, Gonzalez MH: Low Preoperative Albumin Levels Predict Adverse Outcomes After Total Joint Arthroplasty . JBJS 2020, 102 (10):889-895. Schwartz AM, Wilson JM, Farley KX, Bradbury TL, Guild GN: Concomitant Malnutrition and Frailty Are Uncommon, but Significant Risk Factors for Mortality and Complication Following Primary Total Knee Arthroplasty . The Journal of Arthroplasty 2020, 35 (10):2878-2885. Gu A, Malahias M-A, Strigelli V, Nocon AA, Sculco TP, Sculco PK: Preoperative Malnutrition Negatively Correlates With Postoperative Wound Complications and Infection After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis . The Journal of Arthroplasty 2019, 34 (5):1013-1024. Black CS, Goltz DE, Ryan SP, Fletcher AN, Wellman SS, Bolognesi MP, Seyler TM: The Role of Malnutrition in Ninety-Day Outcomes After Total Joint Arthroplasty . The Journal of Arthroplasty 2019, 34 (11):2594-2600. Evans DC, Corkins MR, Malone A, Miller S, Mogensen KM, Guenter P, Jensen GL, Committee AM: The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper . Nutr Clin Pract 2021, 36 (1):22-28. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent J-P, Nicolis I, Benazeth S, Cynober L, Aussel C: Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients2 . The American Journal of Clinical Nutrition 2005, 82 (4):777-783. Fang CJ, Saadat GH, Butler BA, Bokhari F: The Geriatric Nutritional Risk Index Is an Independent Predictor of Adverse Outcomes for Total Joint Arthroplasty Patients . J Arthroplasty 2022, 37 (8s):S836-s841. Jia Z, El Moheb M, Nordestgaard A, Lee JM, Meier K, Kongkaewpaisan N, Han K, El Hechi MW, Mendoza A, King D et al : The Geriatric Nutritional Risk Index is a powerful predictor of adverse outcome in the elderly emergency surgery patient . J Trauma Acute Care Surg 2020, 89 (2):397-404. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C: Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients . Am J Clin Nutr 2005, 82 (4):777-783. Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M, Nyulasi I, Ockenga J, Schneider SM et al : Diagnostic criteria for malnutrition – An ESPEN Consensus Statement . Clinical Nutrition 2015, 34 (3):335-340. Soeters P, Bozzetti F, Cynober L, Forbes A, Shenkin A, Sobotka L: Defining malnutrition: A plea to rethink . Clinical Nutrition 2017, 36 (3):896-901. Chandra RK: Nutrition and the immune system from birth to old age . Eur J Clin Nutr 2002, 56 Suppl 3 :S73-76. Bourke CD, Berkley JA, Prendergast AJ: Immune Dysfunction as a Cause and Consequence of Malnutrition . Trends in Immunology 2016, 37 (6):386-398. Childs CE, Calder PC, Miles EA: Diet and Immune Function . Nutrients 2019, 11 (8):1933. Gillis C, Wischmeyer PE: Pre-operative nutrition and the elective surgical patient: why, how and what? Anaesthesia 2019, 74 Suppl 1 :27-35. Maimaiti Z, Xu C, Fu J, Tianyu Li W, Chai W, Zhou Y, Chen J: A Novel Biomarker to Screen for Malnutrition: Albumin/Fibrinogen Ratio Predicts Septic Failure and Acute Infection in Patients Who Underwent Revision Total Joint Arthroplasty . The Journal of Arthroplasty 2021, 36 (9):3282-3288. Fryhofer GW, Sloan M, Sheth NP: Hypoalbuminemia remains an independent predictor of complications following total joint arthroplasty . Journal of Orthopaedics 2019, 16 (6):552-558. Bala A, Ivanov DV, Huddleston JI, Goodman SB, Maloney WJ, Amanatullah DF: The Cost of Malnutrition in Total Joint Arthroplasty . The Journal of Arthroplasty 2020, 35 (4):926-932.e921. Blevins K, Aalirezaie A, Shohat N, Parvizi J: Malnutrition and the Development of Periprosthetic Joint Infection in Patients Undergoing Primary Elective Total Joint Arthroplasty . The Journal of Arthroplasty 2018, 33 (9):2971-2975. Huang R, Greenky M, Kerr GJ, Austin MS, Parvizi J: The Effect of Malnutrition on Patients Undergoing Elective Joint Arthroplasty . The Journal of Arthroplasty 2013, 28 (8, Supplement):21-24. Nanri Y, Shibuya M, Fukushima K, Uchiyama K, Takahira N, Takaso M: Preoperative malnutrition is a risk factor for delayed recovery of mobilization after total hip arthroplasty . Pm r 2021, 13 (12):1331-1339. Abd Aziz NAS, Mohd Fahmi Teng NI, Kamarul Zaman M: Geriatric Nutrition Risk Index is comparable to the mini nutritional assessment for assessing nutritional status in elderly hospitalized patients . Clinical Nutrition ESPEN 2019, 29 :77-85. Abd-El-Gawad WM, Abou-Hashem RM, El Maraghy MO, Amin GE: The validity of Geriatric Nutrition Risk Index: Simple tool for prediction of nutritional-related complication of hospitalized elderly patients. Comparison with Mini Nutritional Assessment . Clinical Nutrition 2014, 33 (6):1108-1116. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3892380","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":269573052,"identity":"25db5c92-c7f0-42dc-9362-e82b721907d1","order_by":0,"name":"Steven H. Liu","email":"","orcid":"","institution":"Stony Brook University Department of Orthopaedics","correspondingAuthor":false,"prefix":"","firstName":"Steven","middleName":"H.","lastName":"Liu","suffix":""},{"id":269573053,"identity":"6148c6bb-37dc-41ef-9ebb-3194e551012e","order_by":1,"name":"Brandon Lung","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBACA3YQ+cNGDkQdeECUFmYgwdiTZgzWkkC0Fga2w4kNIJooLebMPGYPv/Awp88PO/wQaIudnG4DAS2WzTzmxjIWbLkbb6cZALUkG5sdIOSwwzxm0hI8PLkbZyeAtBxI3EacFjaJdMPZ6R+I1yL5gc0gQV46h0hbLJvZyqQZexIMN0jnFBxIMCDCL+bszdskf/z4Ly8/O33zhw8VdnIEtYAAMw/IhWCVBkQoBwHGH0BCvoFI1aNgFIyCUTDyAABf/ECvv8wdmAAAAABJRU5ErkJggg==","orcid":"","institution":"University of California Irvine Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Brandon","middleName":"","lastName":"Lung","suffix":""},{"id":269573054,"identity":"2320c557-0314-40ba-8ed5-b3dadaace161","order_by":2,"name":"Jane Burgan","email":"","orcid":"","institution":"Stony Brook University Department of Orthopaedics","correspondingAuthor":false,"prefix":"","firstName":"Jane","middleName":"","lastName":"Burgan","suffix":""},{"id":269573055,"identity":"b700aa1d-757f-4a7b-810d-0d72787fc86b","order_by":3,"name":"Rachel A. Loyst","email":"","orcid":"","institution":"Stony Brook University Department of Orthopaedics","correspondingAuthor":false,"prefix":"","firstName":"Rachel","middleName":"A.","lastName":"Loyst","suffix":""},{"id":269573056,"identity":"5d34eb07-fe8c-4d51-8bd1-7d97207926e2","order_by":4,"name":"James J. Nicholson","email":"","orcid":"","institution":"Stony Brook University Department of Orthopaedics","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"J.","lastName":"Nicholson","suffix":""},{"id":269573057,"identity":"214ca8a0-75e0-4aac-8342-74092132b58e","order_by":5,"name":"Russell N. Stitzlein","email":"","orcid":"","institution":"University of California Irvine Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Russell","middleName":"N.","lastName":"Stitzlein","suffix":""}],"badges":[],"createdAt":"2024-01-24 00:29:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3892380/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3892380/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50330242,"identity":"669d73a2-7269-499f-8238-a98210b7fb81","added_by":"auto","created_at":"2024-01-29 21:38:02","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":293140,"visible":true,"origin":"","legend":"\u003cp\u003eCase selection schematic. rTKA, Revision Total Knee Arthroplasty; NSQIP, National Surgical Quality Improvement Program; ASA, American Society of Anesthesiologists\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3892380/v1/5f4804f0f8d437c4a18f9107.jpg"},{"id":76559434,"identity":"8d8151ce-2011-43ef-9fa1-172c697a4f24","added_by":"auto","created_at":"2025-02-18 11:32:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2871366,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3892380/v1/ea88453e-63c5-4897-b928-d981eec0b274.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The geriatric nutritional risk index as a prognostic factor in revision total knee arthroplasty: A retrospective cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTotal knee arthroplasty (TKA) is an effective surgical treatment option for patients with debilitating knee osteoarthritis (OA) seeking to alleviate pain and improve quality of life.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Osteoarthritis is the most prevalent joint disease in the United States, with knee OA accounting for 80% of the disease\u0026rsquo;s total burden.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] The geriatric population is rapidly growing in the United States, resulting in more adults suffering from OA and thus a greater prevalence of TKA.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Revision total knee arthroplasty (rTKA) procedures, which are often performed to correct complications following primary TKA, such as prosthetic infections and joint loosening, are also increasing as more TKAs are being performed.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] The incidence of both TKA and rTKA is expected to rise, with a projected 90% annual increase in rTKA compared to a 43% annual increase in TKA.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eWith a rising incidence of rTKAs, it has become increasingly pertinent to understand patient risk factors and conditions associated with poorer postoperative outcomes. Malnutrition is a well-documented risk factor in orthopedic joint surgery that has been linked to an increased rate of adverse postoperative outcomes, including infection, myocardial infarction, increased length of hospital stay, readmission, and return visits to the emergency department.[\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn the past, serum albumin has been used as a marker for malnutrition. However, due to mixed evidence regarding its validity as a proxy for malnutrition, newer risk indices such as the Geriatric Nutritional Risk Index (GNRI) have been developed.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] GNRI, which assesses the risk of malnutrition in geriatric patients, is calculated using serum albumin and ideal body weight.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Previous literature has demonstrated that GNRI is a predictor of adverse postoperative outcomes following total joint arthroplasty (TJA).[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] However, its utility in assessing the prognosis of geriatric patients who undergo rTKA has not been studied.\u003c/p\u003e \u003cp\u003eThe purpose of this study is to investigate the relationship between GNRI and postoperative outcomes following rTKA. We hypothesized that there is an increased risk of early postoperative complications in patients with GNRI indicative of malnutrition compared to patients with normal GNRI.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eWe queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for all patients who underwent rTKA between 2015 and 2021. This study was exempt from approval by our University\u0026rsquo;s Institutional Review Board because the NSQIP database is fully de-identified. Data in the NSQIP database is obtained from over 600 hospitals in the United States, is collected by trained Surgical Clinical Reviewers, and provides validates 30-day surgical outcomes.\u003c/p\u003e\n\u003cp\u003eThe \u003cem\u003eCurrent Procedural Terminology\u003c/em\u003e (CPT) codes corresponding to rTKA (27486\u0026mdash;one component and 27487\u0026mdash;femoral and entire tibial component) were used to identify 30,557 patients who underwent rTKA between 2015 and 2021. NSQIP inherently excludes all cases of patients under 18 years of age and all cases with primary admission criteria related to trauma. Revisions secondary to periprosthetic joint infections were excluded because the NSQIP does not provide information related to the chronicity of the infection (acute vs. chronic) or the type of revision (one- or two-stage procedure). Thus, cases with the removal of a prosthesis with or without the insertion of a spacer (CPT code 27488), and either sepsis or septic shock at the time of the operation were not included in the study. 13,038 patients with missing height, weight, or preoperative albumin values required to calculate GNRI were excluded, leaving 17,519 patients. Next, 8,110 cases were excluded for missing American Society of Anesthesiologists (ASA) classification, unknown discharges destination, functional health status, age\u0026thinsp;\u0026lt;\u0026thinsp;65, or underwent rTKA due to an infectious cause. GNRI was then calculated for each patient using the following formula, using weight (lb) and albumin (g/L):[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e$$GNRI=\\left(1.489*Albumin\\right)+\\left(41.7*\\frac{Weight}{WLo}\\right)$$\u003c/p\u003e\n\u003cp\u003eWLo is the ideal weight, calculated separately for male and female gender using the Lorentz equations, using height (cm):[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({WLo}_{male}=\\left(Height-100\\right)+\\frac{Height-150}{4}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\n\u003cdiv id=\"FileID_Equb\" class=\"mathdisplay\"\u003e$${WLo}_{female}=\\left(Height-100\\right)-\\frac{Height-150}{2.5}$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eTo not miss overweight or obese patients with malnutrition, the ratio of Weight/WLo was capped at 1 if weight exceeded WLo.[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eThe remaining study population (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) was then indexed into three cohorts based on their preoperative GNRI: normal/reference (GNRI\u0026thinsp;\u0026gt;\u0026thinsp;98), moderate malnutrition (92\u0026thinsp;\u0026le;\u0026thinsp;GNRI\u0026thinsp;\u0026le;\u0026thinsp;98), and severe malnutrition (GNRI\u0026thinsp;\u0026lt;\u0026thinsp;92). These validated cutoffs were chosen based on preexisting research on GNRI in TJA.[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eVariables collected in this study included patient demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data. Patient demographics included gender, body mass index (BMI), age, smoking status, functional status, ASA classification, and preoperative steroid use. Steroid use status was defined as patients who routinely used immunosuppressants or corticosteroids within 30 days pre-procedure. Smoking status was defined as cigarette use at any point within the past year before the procedure. Preoperative comorbidities included congestive heart failure (CHF), diabetes, hypertension, severe chronic obstructive pulmonary disease (COPD), bleeding disorders, and disseminated cancer. 30-day complications included the following: sepsis, septic shock, pneumonia, unplanned reintubation, urinary tract infection (UTI), cardiac arrest or myocardial infarction (MI), stroke, blood transfusions, deep vein thrombosis (DVT), pulmonary embolism (PE), on ventilator\u0026thinsp;\u0026gt;\u0026thinsp;48 hours, surgical space infection (SSI), wound dehiscence, acute renal failure, \u003cem\u003eClostridioides difficile\u003c/em\u003e (\u003cem\u003eC. diff\u003c/em\u003e) infection, non-home discharge, readmission, unplanned reoperation, length of stay (LOS)\u0026thinsp;\u0026gt;\u0026thinsp;2 days, mortality.\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were conducted using SPSS Software version 26.0 (IBM Corp., Armonk, NY, USA). Patient demographics and comorbidities were compared between cohorts using bivariate logistic regression. Multivariate logistic regression, adjusted for all significantly associated patient demographics and comorbidities for the respective cohort, was used to identify associations between preoperative GNRI and postoperative complications. Odds ratios (OR) were reported with 95% confidence intervals (CI). The level of statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eCompared to the normal nutrition group, the moderate malnutrition group was statistically significant for older age groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), abnormal BMI groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) dependent functional status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ASA classification\u0026thinsp;\u0026ge;\u0026thinsp;3 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), smoker (p\u0026thinsp;=\u0026thinsp;0.017), chronic steroid use (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and comorbid CHF (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), diabetes (p\u0026thinsp;=\u0026thinsp;0.005), hypertension (p\u0026thinsp;=\u0026thinsp;0.003), COPD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), bleeding disorders (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Compared to the normal nutrition group, the severe malnutrition group was statistically significant for older age groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), dependent functional status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ASA classification\u0026thinsp;\u0026ge;\u0026thinsp;3 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), chronic steroid use (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and comorbid CHF (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), diabetes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), hypertension (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), COPD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), bleeding disorders (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and disseminated cancer (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePatient demographics and comorbidities for patients with preoperative normal GNRI, moderate malnutrition, and severe malnutrition.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003cp\u003e(GNRI\u0026thinsp;\u0026gt;\u0026thinsp;98)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eModerate malnutrition\u003c/p\u003e\n\u003cp\u003e(92\u0026thinsp;\u0026le;\u0026thinsp;GNRI\u0026thinsp;\u0026le;\u0026thinsp;98)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSevere malnutrition\u003c/p\u003e\n\u003cp\u003e(GNRI\u0026thinsp;\u0026lt;\u0026thinsp;92)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6,658 (100.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,636 (100.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,115 (100.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.243\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.747\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3,850 (57.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e972 (59.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e639 (57.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,808 (42.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e664 (40.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e476 (42.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65\u0026ndash;74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,481 (67.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e955 (58.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e554 (49.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75\u0026ndash;84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,907 (28.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e557 (34.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e402 (36.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e270 (4.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e124 (7.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e159 (14.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI (kg/m^2)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.413\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19 (0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12 (0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7 (0.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.5\u0026ndash;29.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,569 (38.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e551 (33.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e456 (40.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30-34.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,979 (29.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e452 (27.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e285 (25.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35-39.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,288 (19.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e355 (21.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e185 (16.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e803 (12.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e266 (16.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e182 (16.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFunctional status prior to surgery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDependent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e191 (2.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e128 (7.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e156 (14.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndependent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6,467 (97.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,508 (92.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e959 (86.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eASA classification\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;\u0026thinsp;2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,271 (34.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e387 (23.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e131 (11.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,387 (65.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,249 (76.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e984 (88.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSmoker\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.300\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6,364 (95.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,541 (94.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,058 (94.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e294 (4.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e95 (5.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e57 (5.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSteroid use\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6,357 (95.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,526 (93.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,015 (91.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e301 (4.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e110 (6.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100 (9.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCHF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e89 (1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47 (2.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75 (6.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,486 (22.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e419 (25.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e309 (27.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,979 (74.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,282 (78.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e889 (79.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCOPD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e323 (4.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e120 (7.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e113 (10.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBleeding Disorder\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e253 (3.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e107 (6.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e150 (13.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDisseminated Cancer\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.124\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26 (2.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal operation time (minutes)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.817\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.066\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u0026ndash;79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,291 (19.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e310 (18.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e240 (21.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80\u0026ndash;128\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,049 (30.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e526 (32.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e347 (31.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;129\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3,318 (49.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e800 (48.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e528 (47.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eGNRI, Geriatric Nutritional Risk Index; BMI, body mass index; ASA, American Society of Anesthesiologists; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease\u003c/p\u003e\n\u003cp\u003eCompared to the normal nutrition group, the moderate malnutrition group was significantly associated with a greater likelihood of experiencing any complication (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), pneumonia (p\u0026thinsp;=\u0026thinsp;0.017), blood transfusions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), SSI (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), wound dehiscence (p\u0026thinsp;=\u0026thinsp;0.041), non-home discharge (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), readmission (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and mortality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Compared to the normal nutrition group, the severe malnutrition group was significantly associated with a greater likelihood of experiencing any complication (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), septic shock (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), pneumonia (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), unplanned reintubation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), cardiac arrest or MI (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), stroke (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), blood transfusions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), on ventilator\u0026thinsp;\u0026gt;\u0026thinsp;48 hours (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), SSI (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), wound dehiscence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), acute renal failure (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), \u003cem\u003eC. diff\u003c/em\u003e infection (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), non-home discharge (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), readmission (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), unplanned reoperation (p\u0026thinsp;=\u0026thinsp;0.002), LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and mortality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eBivariate analysis of postoperative complications in patients with normal GNRI, moderate malnutrition, and severe malnutrition.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003cp\u003e(GNRI\u0026thinsp;\u0026gt;\u0026thinsp;98)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eModerate malnutrition\u003c/p\u003e\n\u003cp\u003e(92\u0026thinsp;\u0026le;\u0026thinsp;GNRI\u0026thinsp;\u0026le;\u0026thinsp;98)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSevere malnutrition\u003c/p\u003e\n\u003cp\u003e(GNRI\u0026thinsp;\u0026lt;\u0026thinsp;92)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAny complication\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3,139 (47.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,058 (64.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e980 (87.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSepsis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9 (0.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.427\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9 (0.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.073\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSeptic shock\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6 (0.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.315\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9 (0.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePneumonia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18 (0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11 (0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24 (2.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnplanned reintubation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.884\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUTI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e53 (0.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13 (0.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.995\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.128\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCardiac arrest or MI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10 (0.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.228\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19 (1.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eStroke\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8 (0.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1 (0.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.524\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8 (0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBlood transfusions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e323 (4.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e208 (12.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e252 (22.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDVT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43 (0.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13 (0.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.511\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13 (1.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.061\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9 (0.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.482\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6 (0.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.583\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOn ventilator\u0026thinsp;\u0026gt;\u0026thinsp;48 hours\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4 (0.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.144\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11 (1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSSI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e162 (2.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e76 (4.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e78 (7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWound dehiscence\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47 (0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21 (1.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAcute renal failure\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5 (0.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1 (0.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.851\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6 (0.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eClostridioides difficile\u003c/strong\u003e \u003cstrong\u003einfection\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5 (0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.394\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8 (0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNon-home discharge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,392 (20.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e606 (37.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e585 (52.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReadmission\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e341 (5.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e125 (7.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e124 (11.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnplanned reoperation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e214 (3.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54 (3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.859\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e57 (5.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLength of stay\u0026thinsp;\u0026gt;\u0026thinsp;2 days\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,695 (40.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e965 (59.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e925 (83.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePeriprostatic fracture\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.993\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12 (0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24 (2.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eGNRI, Geriatric Nutritional Risk Index; UTI, urinary tract infection; MI, myocardial infarction; DVT, deep vein thrombosis; PE, pulmonary embolism; SSI, surgical space infection\u003c/p\u003e\n\u003cp\u003eAfter controlling for all significant patient demographic and comorbidity factors, an adjusted multivariate regression analysis was conducted (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Compared to the normal nutrition group, the moderate malnutrition group was independently significantly associated with a greater likelihood of experiencing any complications (OR 1.74, 95% CI 1.55\u0026ndash;1.95; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), blood transfusions (OR 2.33, 95% CI 1.92\u0026ndash;2.82; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), SSI (OR 1.74, 95% CI 1.31\u0026ndash;2.32; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), non-home discharge (OR 1.82, 95% CI 1.61\u0026ndash;2.06; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), readmission (OR 1.32, 95% CI 1.07\u0026ndash;1.65; p\u0026thinsp;=\u0026thinsp;0.011), LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days (OR 1.83, 95% CI 1.63\u0026ndash;2.04; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and mortality (OR 2.83, 95% CI 1.22\u0026ndash;6.60; p\u0026thinsp;=\u0026thinsp;0.016). Compared to the normal nutritional group, the severe malnutrition group was independently significantly associated with a greater likelihood of experiencing any complication (OR 5.92, 95% CI 4.89\u0026ndash;7.17; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), septic shock (OR 7.62, 95% CI 2.57\u0026ndash;22.61; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), pneumonia (OR 4.93, 95% CI 2.53\u0026ndash;9.62; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), unplanned reintubation (OR 3.93, 95% CI 1.79\u0026ndash;8.61; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), cardiac arrest or MI (OR 3.29, 95% CI 1.73\u0026ndash;6.27; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), stroke (OR 5.13, 95% CI 1.75-15.00; p\u0026thinsp;=\u0026thinsp;0.003), blood transfusions (OR 3.85, 95% CI 3.16\u0026ndash;4.68; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), on ventilator\u0026thinsp;\u0026gt;\u0026thinsp;48 hours (OR 5.93, 95% CI 1.89\u0026ndash;18.59; p\u0026thinsp;=\u0026thinsp;0.002), SSI (OR 2.61, 95% CI 1.93\u0026ndash;3.52; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), wound dehiscence (OR 2.39, 95% CI 1.37\u0026ndash;4.16; p\u0026thinsp;=\u0026thinsp;0.002), acute renal failure (OR 4.84, 95% CI 1.27\u0026ndash;18.53; p\u0026thinsp;=\u0026thinsp;0.021), non-home discharge (OR 2.87, 95% CI 2.49\u0026ndash;3.32; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), readmission (OR 1.89, 95% CI 1.49\u0026ndash;2.39; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), unplanned reoperation (OR 1.54, 95% CI 1.12\u0026ndash;2.12; p\u0026thinsp;=\u0026thinsp;0.008), LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days (OR 5.45, 95% CI 4.60\u0026ndash;6.46; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and mortality (OR 6.95, 95% CI 3.23\u0026ndash;14.93; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultivariate analysis of postoperative complications in patients with normal GNRI, moderate malnutrition, and severe malnutrition.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eModerate malnutrition\u003c/p\u003e\n\u003cp\u003e(92\u0026thinsp;\u0026le;\u0026thinsp;GNRI\u0026thinsp;\u0026le;\u0026thinsp;98)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSevere malnutrition\u003c/p\u003e\n\u003cp\u003e(GNRI\u0026thinsp;\u0026lt;\u0026thinsp;92)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR, p value (95% CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR, p value (95% CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAny complication\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.74, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (1.55\u0026ndash;1.95)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.92, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (4.89\u0026ndash;7.17)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSeptic shock\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7.62, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (2.57\u0026ndash;22.61)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePneumonia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.69, 0.184 (0.78\u0026ndash;3.67)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.93, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (2.53\u0026ndash;9.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnplanned reintubation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.93, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (1.79\u0026ndash;8.61)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCardiac arrest or MI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.29, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (1.73\u0026ndash;6.27)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eStroke\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.51, 0.525 (0.06\u0026ndash;4.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.13, \u003cstrong\u003e0.003\u003c/strong\u003e (1.75-15.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBlood transfusions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.33, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (1.92\u0026ndash;2.82)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.85, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (3.16\u0026ndash;4.68)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOn ventilator\u0026thinsp;\u0026gt;\u0026thinsp;48 hours\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.93, \u003cstrong\u003e0.002\u003c/strong\u003e (1.89\u0026ndash;18.59)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSSI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.74, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (1.31\u0026ndash;2.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.61, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (1.93\u0026ndash;3.52)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWound dehiscence\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.39, \u003cstrong\u003e0.002\u003c/strong\u003e (1.37\u0026ndash;4.16)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAcute renal failure\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.84, \u003cstrong\u003e0.021\u003c/strong\u003e (1.27\u0026ndash;18.53)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eClostridioides difficile\u003c/strong\u003e \u003cstrong\u003einfection\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.08, 0.149 (0.77\u0026ndash;5.64)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNon-home discharge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.82, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (1.61\u0026ndash;2.06)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.87, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (2.49\u0026ndash;3.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReadmission\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.32, \u003cstrong\u003e0.011\u003c/strong\u003e (1.07\u0026ndash;1.65)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.89, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (1.49\u0026ndash;2.39)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnplanned reoperation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.54, \u003cstrong\u003e0.008\u003c/strong\u003e (1.12\u0026ndash;2.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLength of stay\u0026thinsp;\u0026gt;\u0026thinsp;2 days\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.83, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (1.63\u0026ndash;2.04)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.45, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (4.60\u0026ndash;6.46)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.83, \u003cstrong\u003e0.016\u003c/strong\u003e (1.22\u0026ndash;6.60)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.95, \u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e (3.23\u0026ndash;14.93)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eGNRI, Geriatric Nutritional Risk Index; OR, odds ratio; CI, confidence interval; MI, myocardial infarction; SSI, surgical space infection\u003c/p\u003e\n\u003cp\u003eIn general, compared to the normal nutrition group, severe malnutrition was independently significantly associated with a greater number of complications than moderate malnutrition. Moreover, for complications independently significantly associated with both moderate and severe malnutrition, severe malnutrition was generally found to have stronger associations: any complication (OR 1.74 in moderate malnutrition vs. 5.92 in severe malnutrition), blood transfusions (OR 2.33 vs. 3.85), SSI (OR 1.74 vs. 2.61), non-home discharge (OR 1.82 vs 2.87), readmission (OR 1.32 vs. 1.89), LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days (OR 1.83 vs. 5.45), and mortality (OR 2.83 vs. 6.95).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we found that compared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, blood transfusions, SSI, non-home discharge, readmission, LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days, and mortality. Severe malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, septic shock, pneumonia, unplanned reintubation, cardiac arrest or myocardial infarction, stroke, blood transfusions, on ventilator\u0026thinsp;\u0026gt;\u0026thinsp;48 hours, SSI, wound dehiscence, acute renal failure, non-home discharge, readmission, unplanned reoperation, LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days, and mortality. Severe malnutrition was independently significantly associated with a greater number of complications and had a stronger association with complications compared to moderate malnutrition.\u003c/p\u003e \u003cp\u003eMalnutrition was recently defined by the European Society of Clinical Nutrition and Metabolism as \u0026ldquo;BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e, or an unintentional weight loss\u0026thinsp;\u0026gt;\u0026thinsp;10% of initial body weight with BMI\u0026thinsp;\u0026lt;\u0026thinsp;20 kg/m\u003csup\u003e2\u003c/sup\u003e if\u0026thinsp;\u0026lt;\u0026thinsp;70 years of age or BMI\u0026thinsp;\u0026lt;\u0026thinsp;22 kg/m\u003csup\u003e2\u003c/sup\u003e if older than 70 years, or fat-free mass index\u0026thinsp;\u0026lt;\u0026thinsp;15 and 17 kg/m\u003csup\u003e2\u003c/sup\u003e in women and men respectively.\u0026rdquo;[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] While this definition has been widely used, there exist critics who advocate for the consideration of measures reflecting bodily function such as inflammation.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] It has been well established that malnutrition downregulates the immune response by suppressing immunologic functions such as lymphocyte production and antibody secretion.[\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] These processes may be especially detrimental in post-operative patients who need a robust immune response to repair wounds, prevent catabolic states, and fight off infections.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur analysis found that both moderate and severe malnutrition were commonly significantly associated with an older demographic, dependent functional status, ASA classification\u0026thinsp;\u0026ge;\u0026thinsp;3, steroid use, CHF, diabetes, hypertension, COPD, and bleeding disorder. One study investigating the albumin-to-fibrinogen ratio as a proxy for malnutrition also found that diabetes and an ASA classification\u0026thinsp;\u0026ge;\u0026thinsp;3 were significantly associated with malnourished patients.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Another study reviewing the relationship between hypoalbuminemia and TJA found that malnourished patients had significant associations with dependent functional status, steroid use, smoking, and multiple comorbidities.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Moreover, CHF, bleeding disorders, and metastatic cancer have been documented as significantly associated demographics in malnourished patients who receive TJA.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] Thus, our findings support preexisting literature showing that malnourished patients have a greater number of comorbidities compared to patients with normal nutrition.\u003c/p\u003e \u003cp\u003eWe found both moderate and severe malnutrition to be significantly associated with an increased likelihood of experiencing any postoperative complication. The moderate malnutrition group was independently significantly associated with blood transfusions, SSI, non-home discharge, readmission, LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days, and mortality, while the severe malnutrition group was independently significantly associated with septic shock, pneumonia, unplanned reintubation, cardiac arrest or MI, stroke, blood transfusions, on ventilator\u0026thinsp;\u0026gt;\u0026thinsp;48 hours, SSI, wound dehiscence, acute renal failure, non-home discharge, readmission, unplanned reoperation, LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days, and mortality. Our findings support existing literature showing that malnutrition is linked to infections and wound complications following rTKA.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] Furthermore, our results demonstrate that similar to malnourished patients who undergo TJA, malnourished patients who undergo rTKA are more likely to experience poorer outcomes postoperatively.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAs the average age of patients who undergo rTHA increases[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], methods for quantifying nutritional status must be sufficiently robust to differentiate between normal changes with age versus changes due to poor nutrition. GNRI was developed to quantify the risk of malnutrition in older adults as an alternative to hypoalbuminemia and BMI, which have been criticized for their one-dimensionality and inability to consider the systemic processes related to malnutrition.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] In our study, only 0.7% and 0.6% of moderately and severely malnourished patients respectively had BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5, showing that the utility of BMI in determining nutrition status is limited in isolation. However, GNRI combines features of body weight and serum albumin, using body weight to modulate the degree of albumin discrepancy required for malnourished classification. That is, patients with ideal body weight require a greater albumin abnormality to be considered malnourished based on GNRI compared to patients with lower than ideal body weight.\u003c/p\u003e \u003cp\u003eWhile other malnutrition indices such as the Mini Nutritional Assessment (MNA) exist, GNRI has proven to have the most clinical utility, demonstrating better sensitivity in predicting three- and six-month mortality rates as well as better specificity and diagnostic power compared to MNA.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] Furthermore, GNRI is a simple and efficient means of diagnosing malnutrition\u0026mdash;only requiring height, weight, and albumin levels\u0026mdash;and has the added benefit of not requiring a caregiver to be present.[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] For these reasons, the incorporation of GNRI as an adjuvant screening tool for malnutrition in geriatric patients undergoing rTKA should be considered.\u003c/p\u003e \u003cp\u003eThere exist limitations in our study due to the characteristics of the NSQIP database. We were limited to short-term, 30-day postoperative outcomes, limiting our ability to draw conclusions regarding GNRI as a predictor of long-term adverse outcomes. Additionally, we excluded a proportion of patients from our initial query due to missing height, weight, and albumin. Serum albumin is not routinely collected preoperatively if a patient is clinically low risk. Therefore, there may exist some degree of selection bias in our study. Furthermore, the database does not report information related to management, including pre- or postoperative nutritional supplementation that holds the ability to impact outcomes.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study to investigate the association between GNRI and postoperative outcomes following rTKA. Our study contributes to the current findings of malnutrition in orthopedic surgeries, focusing on the growing population of older adults undergoing rTKA to better understand how to improve patient perioperative and postoperative treatment plans based on their risk factors.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn geriatric patients with GNRI indicative of malnutrition, the overall rate of complication following rTKA was found to increase with increasing severity of malnutrition. Compared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, blood transfusions, SSI, non-home discharge, readmission, LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days, and mortality. Severe malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, septic shock, pneumonia, unplanned reintubation, cardiac arrest or MI, stroke, blood transfusions, on ventilator\u0026thinsp;\u0026gt;\u0026thinsp;48 hours, SSI, wound dehiscence, acute renal failure, non-home discharge, readmission, unplanned reoperation, LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days, and mortality. Our results show that GNRI is a strong predictor of early postoperative complications for geriatric rTKA patients and support its utility as an adjunctive risk stratification tool for geriatric patients undergoing rTKA.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of California Irvine Institutional Review Board deemed this study IRB exempt given that this study was retrospective, and the data studied was already de-identified and publicly available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are available in the NSQIP repository, https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors of this manuscript have no funding sources to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSL and RL compiled the data for this manuscript. SL, BL, RL, and JB ran the data and constructed the manuscript. JN and RS performed thorough manuscript editing and aided with drafting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdie S, Harris I, Chuan A, Lewis P, Naylor JM: \u003cstrong\u003eSelecting and optimising patients for total knee arthroplasty\u003c/strong\u003e. \u003cem\u003eMed J Aust \u003c/em\u003e2019, \u003cstrong\u003e210\u003c/strong\u003e(3):135-141.\u003c/li\u003e\n\u003cli\u003eGademan MG, Hofstede SN, Vliet Vlieland TP, Nelissen RG, Marang-van de Mheen PJ: \u003cstrong\u003eIndication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview\u003c/strong\u003e. \u003cem\u003eBMC Musculoskelet Disord \u003c/em\u003e2016, \u003cstrong\u003e17\u003c/strong\u003e(1):463.\u003c/li\u003e\n\u003cli\u003eWallace IJ, Worthington S, Felson DT, Jurmain RD, Wren KT, Maijanen H, Woods RJ, Lieberman DE: \u003cstrong\u003eKnee osteoarthritis has doubled in prevalence since the mid-20th century\u003c/strong\u003e. \u003cem\u003eProc Natl Acad Sci U S A \u003c/em\u003e2017, \u003cstrong\u003e114\u003c/strong\u003e(35):9332-9336.\u003c/li\u003e\n\u003cli\u003eBashinskaya B, Zimmerman RM, Walcott BP, Antoci V: \u003cstrong\u003eArthroplasty Utilization in the United States is Predicted by Age-Specific Population Groups\u003c/strong\u003e. \u003cem\u003eISRN Orthop \u003c/em\u003e2012, \u003cstrong\u003e2012\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eNorman K, Ha\u0026szlig; 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Comparison with Mini Nutritional Assessment\u003c/strong\u003e. \u003cem\u003eClinical Nutrition \u003c/em\u003e2014, \u003cstrong\u003e33\u003c/strong\u003e(6):1108-1116.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"knee, revision total knee arthroplasty, malnutrition, geriatric, geriatric nutritional risk index, complications, postoperative","lastPublishedDoi":"10.21203/rs.3.rs-3892380/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3892380/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a readily available index measuring the risk of malnutrition, and 30-day postoperative complications following revision total knee arthroplasty (rTKA).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients\u0026thinsp;\u0026ge;\u0026thinsp;65 who underwent rTKA between 2015 and 2021. The study population was divided into three groups based on preoperative GNRI: normal/reference (GNRI\u0026thinsp;\u0026gt;\u0026thinsp;98), moderate malnutrition (92\u0026thinsp;\u0026le;\u0026thinsp;GNRI\u0026thinsp;\u0026le;\u0026thinsp;98), and severe malnutrition (GNRI\u0026thinsp;\u0026lt;\u0026thinsp;92). Multivariate logistic regression analysis was conducted to investigate the association between preoperative GNRI and postoperative complications.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eCompared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, blood transfusions, surgical site infection (SSI), non-home discharge, readmission, length of stay (LOS)\u0026thinsp;\u0026gt;\u0026thinsp;2 days, and mortality. Severe malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, septic shock, pneumonia, unplanned reintubation, cardiac arrest or myocardial infarction, stroke, blood transfusions, still on ventilator\u0026thinsp;\u0026gt;\u0026thinsp;48 hours, SSI, wound dehiscence, acute renal failure, non-home discharge, readmission, unplanned reoperation, LOS\u0026thinsp;\u0026gt;\u0026thinsp;2 days, and mortality. Severe malnutrition was independently significantly associated with a greater number of complications and had a stronger association with complications compared to moderate malnutrition.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMalnutrition identified by GNRI has strong predictive value for short-term postoperative complications following rTKA in geriatric patients and may have utility as an adjunctive risk stratification tool for geriatric patients undergoing rTKA.\u003c/p\u003e","manuscriptTitle":"The geriatric nutritional risk index as a prognostic factor in revision total knee arthroplasty: A retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-29 21:37:57","doi":"10.21203/rs.3.rs-3892380/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"64edddd5-60f8-4ef5-8ee0-bb1430eac497","owner":[],"postedDate":"January 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-18T11:23:50+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-29 21:37:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3892380","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3892380","identity":"rs-3892380","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}