The geriatric nutritional risk index as a strong predictor of adverse outcomes following total shoulder arthroplasty.

BACKGROUND: This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a simple readily available measure of malnutrition risk, and 30-day postoperative complications following total shoulder arthroplasty (TSA).

METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2021. The study population was divided into 3 groups based on preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92). Logistic regression analysis was conducted to investigate the connection between preoperative GNRI and postoperative complications.

RESULTS: Compared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of any complications (odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.54-1.96; P  < .001), blood transfusions (OR: 1.52, 95% CI: 1.09-2.11; P  = .013), failure to wean off a ventilator within 48 hours (OR: 3.84, 95% CI: 1.26-11.72; P  = .018), wound dehiscence (OR: 15.80, 95% CI: 1.61-155.28; P  = .018), nonhome discharge (OR: 1.90, 95% CI: 1.63-2.22; P  < .001), readmission (OR: 1.54, 95% CI: 1.19-1.99; P  = .001), unplanned reoperation (OR: 1.87, 95% CI: 1.27-2.74; P  = .001), length of stay > 2 days (OR: 1.85, 95% CI: 1.63-2.12; P  < .001), and mortality (OR: 3.38, 95% CI: 1.32-8.71; P  = .011). Severe malnutrition was independently significantly associated with a greater likelihood of any complication (OR: 3.33, 95% CI: 2.80-3.97; P  < .001), sepsis (OR: 9.83, 95% CI: 2.94-32.85; P  < .001), pneumonia (OR: 3.30, 95% CI: 1.71-6.38; P  < .001), unplanned reintubation (OR: 5.77, 95% CI: 2.47-13.51; P  < .001), urinary tract infection (OR: 2.15, 95% CI: 1.19-3.87; P  = .011), stroke (OR: 3.57, 95% CI: 1.18-10.84; P  = .024), blood transfusions (OR: 5.27, 95% CI: 3.86-7.20; P  < .001), failure to wean off a ventilator within 48 hours (OR: 7.64, 95% CI: 2.29-25.55; P  < .001), Clostridioides difficile infection (OR: 4.17, 95% CI: 1.21-14.32; P  = .023), nonhome discharge (OR: 3.56, 95% CI: 2.92-4.34; P  < .001), readmission (OR: 2.05, 95% CI: 1.46-2.89; P  < .001), length of stay > 2 days (OR: 3.27, 95% CI: 2.73-3.92; P  < .001), and mortality (OR: 4.61, 95% CI: 1.51-14.04; P  = .007).

CONCLUSION: Malnutrition based on GNRI is a strong predictor of complications following TSA, with increasing severity related to an increased rate of complications.