Abstract
BACKGROUND: Open reduction and internal fixation (ORIF) surgery of distal humerus fractures is common however the effects of preoperative malnutrition on postoperative outcomes is not known. This study aims to evaluate the impact of malnutrition prior to surgery on both short-term and long-term outcomes following ORIF of distal humerus fractures. METHODS: This retrospective cohort study leveraged a large national database. Adult patients who underwent distal humerus ORIF were divided based on preoperative malnutrition status, defined using previously published parameters by the presence of at least one of the following lab values within one year before surgery: transferrin ≤204 mg/dL, leukocytes ≤1.5 × 10(3)/μL, or albumin ≤3.5 g/dL. Matching protocols were employed to arrive at two balanced cohorts. RESULTS: Within 90-days after surgery, malnourished patients had nearly double the risk of hospital readmission (RR = 1.87; p < 0.001) and more than double the risk of postoperative anemia (RR = 2.19; p < 0.001). Wound complications were modestly associated with malnourished patients (RR = 1.41; p = 0.05). Within 2 years postoperatively, malnutrition was associated with a significantly higher rate of nonunion (RR = 2.15; p = 0.003). CONCLUSION: Preoperative malnutrition was linked to worse outcomes after distal humerus ORIF, including higher rates of nonunion, postoperative anemia, readmission rates, and, to a moderate degree, wound complications. The findings of this study emphasize the need for enhanced nutritional status screening prior to surgery to reduce avoidable postoperative risks.