Overview
Research Article Title: Preoperative malnutrition is associated with increased risk of 90-day major medical complications and increased 2-year revision rates following total shoulder arthroplasty
Authors: Jad J Lawand et al.
Published in: Journal of Shoulder and Elbow Surgery
Date of Publication: 16 April 2025
Link to Article: PMID: 40250824 →; DOI: 10.1016/j.jse.2025.03.005
Summary
Malnutrition continues to be a modifiable risk factor for adverse surgical outcomes across multiple specialties. This study evaluates the association between preoperative malnutrition and short-term (90 days) and long-term (2 years) post-operative complications for total shoulder arthroplasty (TSA) patients.
Key Findings:
- Short Term: Increased risk of sepsis, myocardial infarction, pneumonia, renal failure, blood transfusion, and readmission.
- Long Term: Higher rates of periprosthetic joint infection (PJI) and revision TSA.
- No differences in surgical site infection, pulmonary embolism, stroke, periprosthetic fractures, or mechanical loosening.
Methodology
This retrospective cohort study evaluated patients who underwent TSA between 2004–2022 using data from 62 US-based healthcare organizations (TriNetX). Patients were grouped based on preoperative lab results:
- Serum albumin < 3.5 g/dL
- Transferrin < 204 mg/dL
- Total leukocyte count < 1500 cells/mm³
1,980 patients were in the malnutrition group and 19,096 in the control group before matching. After 1:1 propensity matching, each group included 1,936 patients.
Why It Matters
90-Day Postoperative Outcomes:
- Higher risk of sepsis, myocardial infarction, pneumonia, renal failure, transfusion, and readmission with pre-op malnutrition.
2-Year Postoperative Outcomes:
- Significantly higher rates of PJI and revision TSA in malnourished patients.
Limitations
Malnutrition was defined by biomarkers only—unable to assess severity beyond lab values and demographics. Albumin alone is an outdated marker and can be influenced by non-nutritional factors.
Academy of Nutrition and Dietetics / ASPEN definition includes:
- Insufficient energy intake
- Weight loss
- Loss of muscle mass
- Loss of subcutaneous fat
- Fluid accumulation
- Decreased hand grip strength
Final Thoughts
Malnutrition remains a modifiable risk factor with meaningful impact on surgical outcomes. Standardized protocols for screening and treatment are lacking.
Recommendations:
- Implement pre-op nutrition screening (e.g., MUST or adapted tools for surgical patients).
- Use the pre-op period as a teachable moment to intervene with evidence-based nutrition and supplements.
- Integrate Registered Dietitians into surgical care teams for expert assessment and support.
Want to bring expert nutrition support to your patients?
Explore how Mend and the Upgraid Care Team can support your practice. Learn more → or contact us at partners@mend.me.
This article was written by Katie Frushour, MS, RD, CSSD, a dietitian at Mend.
