Predicting Postoperative Complications and Mortality in Total Joint Arthroplasty: The Role of the Geriatric Nutritional Risk Index

Objective: Total joint arthroplasty (TJA) significantly improves the quality of life of individuals with severe arthritis.Despite its success, postoperative complications can affect outcomes and increase healthcare costs.Malnutrition has been identified as a key predictor of adverse surgical outcomes, including increased risk of infection and impaired wound healing.This study aimed to assess the predictive value of the geriatric nutritional risk index (GNRI) for 90-day postoperative complications and one-year mortality in patients undergoing TJA.This study investigates whether lower GNRI scores are associated with higher incidences of complications and mortality. Methods:A retrospective analysis was conducted on patients over 65 years of age who underwent elective hip or knee arthroplasty between 2013 and 2022.GNRI was calculated using postoperative serum albumin levels and the ratio of current body weight to ideal body weight.Patients were categorized on the basis of GNRI scores to evaluate their risk of postoperative complications and mortality. Results:The study included 723 patients, with a mean age of 70.4±2.7 years and a mean body mass index of 26.31±0.98.Postoperative GNRI identified 55.7% (n=403) of patients as having normal nutritional status, 41.5% (n=300) as low risk, and 2.8% (n=20) as moderate/severe risk.Complications within the 90-day postoperative period were observed in 4.7% (n=34) of patients, and the 1-year mortality rate was 2.1%.Patients in the moderate/severe malnutrition category had significantly higher rates of complications and mortality (p<0.001). Conclusion:Lower postoperative GNRI values are significantly associated with increased rates of 90-day complications and 1-year mortality in patients with TJA, highlighting the importance of nutritional status in surgical outcomes.GNRI is a valuable tool for identifying patients at risk of postoperative complications and mortality following TJA.Addressing nutritional deficiencies preoperatively could enhance recovery and reduce adverse outcomes, emphasizing the need for nutritional assessments in the surgical management of elderly patients.