RESUMEN
OBJECTIVE: To investigate whether the physiological response to surgery-induced stress, as measured by changes in serum secretory proteins, is more profound on older than in younger total joint arthroplasty patients. DESIGN: Retrospective study. SETTING: A 267-bed teaching hospital. PARTICIPANTS: A total of 220 ambulatory patients with normal admission serum albumin levels, of whom 106 were 65 years of age or older (mean age 73.3 +/- 6.2 years) and 114 less than age 65 (mean age 48.8 +/- 12.2 years). METHODS: Serum albumin and transferrin levels obtained at admission an on the fifth and tenth postoperative days were compared in the two age groups. RESULTS: In both age groups, admission serum albumins were significantly higher than on the corresponding postoperative Day 5 levels (40.4 +/- 3.7 g/L vs 25.0 +/- 3.3 g/L, P < .0001 and 39.5 +/- 2.5 g/L vs 23.9 +/- 3.1 g/L, P < .001 in older and younger patients, respectively). The drop in the serum concentration of albumin by postoperative Day 5 in the older patients was not significantly different from that of the younger patients (a drop of 15.6 +/- 3.3 g/L in older vs 15.4 +/- 4.4 g/L for the younger, P = .740). Among the 64 patients who remained in the hospital 10 days subsequent to surgery, the average postoperative Day 10 serum albumin concentration was significantly lower in the older patients when compared with the younger (26.2 vs 29.1 g/L P = .016). Similar results were obtained for serum transferrin. CONCLUSIONS: Subsequent to elective arthroplasty, the magnitude of change in serum albumin and transferrin concentrations is similar in older compared with younger, patients, suggesting that this stress response to surgery is nor age dependent. In contrast, the rate of recovery of the serum protein concentrations to preoperative levels may be slower in the older patients. However, this issue needs to be investigated further.
Asunto(s)
Envejecimiento/sangre , Artroplastia , Albúmina Sérica/fisiología , Estrés Fisiológico/sangre , Transferrina/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Periodo Posoperatorio , Estudios RetrospectivosRESUMEN
One hundred consecutive orthopedic long bone fracture patients requiring surgical fixation were nutritionally assessed using both the nutritional index of Rainey-MacDonald et al. and total lymphocyte count. The ability of these two parameters to identify correctly those patients who do and do not develop postoperative complications was assessed using several error rate measures, which included sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Fourteen of our patients developed postoperative complications. All complications observed were infections. The accuracy of the nutritional index and total lymphocyte count in predicting patient outcome was 78 and 51%, respectively. The positive and negative predictive values calculated for the nutritional index were 36 and 94%, respectively. Total lymphocyte count analysis resulted in positive and negative predictive values of 15 and 87%, respectively. In our sample of patients, the nutritional index was a better predictor of patient outcome than total lymphocyte count, as indicated by the higher accuracy rate calculated for the nutritional index. Based upon positive predictive value results, neither of these indicators was most accurate in identifying patients who did develop infections. Not unexpectedly, both indicators were best in identifying those patients who did not develop postoperative infections.