Selective preoperative nutrition-related testing and adverse outcomes after primary total joint arthroplasty: a retrospective cohort study

Preoperative nutritional vulnerability is a modifiable risk factor for adverse outcomes after total joint arthroplasty (TJA), but the utility of common nutrition-related biomarkers is unclear. This study evaluated associations between preoperative nutritional biomarkers, derived indices, and adverse postoperative outcomes after primary TJA. This retrospective cohort included 2,101 patients undergoing primary hip, knee, or shoulder arthroplasty from June 2022 through March 14, 2025, ensuring 365 days of potential follow-up. Nutrition-related biomarkers measured within 30 days before surgery were analyzed using available cases without imputation. The outcome was a chart-adjudicated composite of an index-joint complication and/or revision within 365 days. Separate Firth penalized logistic models adjusted for age and arthroplasty type. Five continuous biomarker comparisons were exploratory and adjusted using the Benjamini-Hochberg procedure. An inverse-probability-of-testing-weighted analysis evaluated selection related to albumin testing. Seventy-five patients (3.6%) experienced the composite outcome. Albumin was available in 241 patients, TLC in 471, total protein in 218, OPNI in 130, and GNRI in 239. Higher albumin was associated with lower odds of the composite outcome (OR 0.29 per 1 g/dL, 95% CI 0.12–0.73; q = .048). The weighted estimate was similar (OR 0.24, 95% CI 0.11–0.54). OPNI and TLC were nominally associated but did not meet the false-discovery-rate threshold; total protein and GNRI were not associated. Among selectively tested primary TJA patients, higher preoperative albumin was associated with fewer adjudicated adverse outcomes within 365 days. OPNI and TLC showed nominal associations but did not meet the false-discovery-rate threshold, whereas total protein and GNRI were not associated. These exploratory findings support prospective evaluation using standardized preoperative biomarker collection. not applicable.