{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T08:01:20Z","timestamp":1783238480725,"version":"3.54.6"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The purpose of this investigation was to identify the prevalence of hypoalbuminemia and obesity in orthopaedic trauma patients with high-energy injuries and to investigate their impact on the incidence of surgical site complications. Patients 18 years of age and older undergoing intramedullary nail fixation of their femoral shaft fractures at a university-based level-1 trauma centre were assessed. Malnutrition was measured using serum markers (albumin &lt;3.5\u2009g\/dL) as well as body mass index (BMI) as a marker of obesity (BMI\u2009&gt;\u200930\u2009kg\/m<jats:sup>2<\/jats:sup>). The primary outcome measure was surgical wound complications. A total of 249 patients were included in this study. Ninety-eight patients (39.4%) presented with hypoalbuminaemia and 80 patients (32.1%) were obese. The overall incidence of wound complications in our study population was 9.65% (n\u2009=\u200925\/259). A logistic regression model showed that non-obese patients (BMI\u2009&lt;\u200930\u2009kg\/m<jats:sup>2<\/jats:sup>) were at significantly reduced risk for perioperative wound complications (Odds Ratio 0.400 [95% confidence interval 0.168, 0.954], p\u2009=\u20090.039). This study demonstrated a substantial prevalence of hypoalbuminemia and obesity among orthopaedic trauma patients with high-energy injuries. Obesity may increase the risk of surgical site complications. Future studies are required to further define malnutrition and its correlation with surgical site complications in orthopaedic trauma patients.<\/jats:p>","DOI":"10.1038\/s41598-020-58987-4","type":"journal-article","created":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T11:04:48Z","timestamp":1580987088000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Hypoalbuminemia and Obesity in Orthopaedic Trauma Patients: Body Mass Index a Significant Predictor of Surgical Site Complications"],"prefix":"10.1038","volume":"10","author":[{"given":"Ryan C.","family":"Egbert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor T.","family":"Bouck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil N.","family":"Gupte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miren M.","family":"Pena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khang H.","family":"Dang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel S.","family":"Ornell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris A.","family":"Zelle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,2,6]]},"reference":[{"key":"58987_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bmjdrc-2017-000471","volume":"6","author":"N Ahmed","year":"2018","unstructured":"Ahmed, N. et al. Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis. BMJ Open. Diabetes Res. Care. 6, 1 (2018).","journal-title":"BMJ Open. Diabetes Res. Care."},{"key":"58987_CR2","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.2147\/COPD.S85831","volume":"10","author":"CW Chen","year":"2015","unstructured":"Chen, C. W. et al. Severe hypoalbuminemia is a strong independent risk factor for acute respiratory failure in COPD: a nationwide cohort study. Int. J. Chron. Obstruct Pulmon Dis. 10, 1147\u20131154 (2015).","journal-title":"Int. J. Chron. Obstruct Pulmon Dis."},{"key":"58987_CR3","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.jstrokecerebrovasdis.2009.01.015","volume":"19","author":"B Famakin","year":"2010","unstructured":"Famakin, B. et al. Hypoalbuminemia predicts acute stroke mortality: Paul Coverdell Georgia Stroke Registry. J. Stroke Cerebrovasc. Dis. 19, 17\u201322 (2010).","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"58987_CR4","doi-asserted-by":"publisher","DOI":"10.1186\/s12937-015-0081-5","volume":"14","author":"WH Hu","year":"2015","unstructured":"Hu, W. H. et al. Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP. Nutr. J. 14, 91 (2015).","journal-title":"Nutr. J."},{"key":"58987_CR5","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s11255-016-1453-2","volume":"49","author":"M Shao","year":"2017","unstructured":"Shao, M., Wang, S. & Parameswaran, P. K. Hypoalbuminemia: a risk factor for acute kidney injury development and progression to chronic kidney disease in critically ill patients. Int. Urol. Nephrol. 49, 295\u2013302 (2017).","journal-title":"Int. Urol. Nephrol."},{"key":"58987_CR6","doi-asserted-by":"publisher","first-page":"1740","DOI":"10.1016\/j.amjcard.2017.02.051","volume":"119","author":"H Wada","year":"2017","unstructured":"Wada, H. et al. Prognostic impact of the Geriatric Nutritional Risk Index on long-term outcomes in patients who underwent percutaneous coronary intervention. Am. J. Cardiol. 119, 1740\u20131745 (2017).","journal-title":"Am. J. Cardiol."},{"key":"58987_CR7","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1080\/0284186X.2016.1267872","volume":"56","author":"S van Rooijen","year":"2017","unstructured":"van Rooijen, S. et al. Preoperative modifiable risk factors in colorectal surgery: an observational cohort study identifying the possible value of prehabilitation. Acta Oncol. 56, 329\u2013334 (2017).","journal-title":"Acta Oncol."},{"key":"58987_CR8","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jss.2016.05.030","volume":"205","author":"C Mosquera","year":"2016","unstructured":"Mosquera, C. et al. Impact of malnutrition on gastrointestinal surgical patients. J. Surg. Res. 205, 95\u2013101 (2016).","journal-title":"J. Surg. Res."},{"key":"58987_CR9","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.1007\/s11605-016-3195-y","volume":"20","author":"AN Martin","year":"2016","unstructured":"Martin, A. N. et al. Morbidity and mortality after gastrectomy: identification of modifiable risk factors. J. Gastrointest. Surg. 20, 1554\u20131564 (2016).","journal-title":"J. Gastrointest. Surg."},{"key":"58987_CR10","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.1016\/j.arth.2016.04.032","volume":"31","author":"MC Fu","year":"2016","unstructured":"Fu, M. C. et al. Malnutrition increases with obesity and is a stronger independent risk factor for postoperative complications: a propensity-adjusted analysis of total hip arthroplasty patients. J. Arthroplasty. 31, 2415\u20132421 (2016).","journal-title":"J. Arthroplasty."},{"key":"58987_CR11","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.arth.2013.05.038","volume":"28","author":"R Huang","year":"2013","unstructured":"Huang, R., Greenky, M., Kerr, G. J., Austin, M. S. & Parvizi, J. The effect of malnutrition on patients undergoing elective joint arthroplasty. J. Arthroplasty. 28, 21\u201324 (2013).","journal-title":"J. Arthroplasty."},{"key":"58987_CR12","doi-asserted-by":"publisher","first-page":"3163","DOI":"10.1007\/s11999-015-4333-7","volume":"473","author":"CL Nelson","year":"2015","unstructured":"Nelson, C. L., Elkassabany, N. M., Kamath, A. F. & Liu, J. Low albumin levels, more than morbid obesity, are associated with complications after TKA. Clin. Orthop. Relat. Res. 473, 3163\u20133172 (2015).","journal-title":"Clin. Orthop. Relat. Res."},{"key":"58987_CR13","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1097\/BRS.0000000000001551","volume":"41","author":"O Adogwa","year":"2016","unstructured":"Adogwa, O. et al. Preoperative nutritional status is an independent predictor of 30-day hospital readmission after elective spine surgery. Spine. 41, 1400\u20131404 (2016).","journal-title":"Spine."},{"key":"58987_CR14","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1097\/BSD.0000000000000181","volume":"29","author":"MC Fu","year":"2016","unstructured":"Fu, M. C., Buerba, R. A. & Grauer, J. N. Preoperative nutritional status as an adjunct predictor of major postoperative complications following anterior cervical discectomy and fusion. Clin. Spine Surg. 29, 167\u2013172 (2016).","journal-title":"Clin. Spine Surg."},{"key":"58987_CR15","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1097\/BRS.0000000000001969","volume":"42","author":"V Puvanesarajah","year":"2017","unstructured":"Puvanesarajah, V. et al. Poor nutrition status and lumbar spine fusion surgery in the elderly: readmissions, complications, and mortality. Spine. 42, 979\u2013983 (2017).","journal-title":"Spine."},{"key":"58987_CR16","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1016\/j.injury.2016.12.016","volume":"48","author":"S Aldebeyan","year":"2017","unstructured":"Aldebeyan, S., Nooh, A., Aoude, A., Weber, M. H. & Harvey, E. J. Hypoalbuminaemia-a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures. Injury. 48, 436\u2013440 (2017).","journal-title":"Injury."},{"key":"58987_CR17","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1177\/0148607108314760","volume":"32","author":"JI Botella-Carretero","year":"2008","unstructured":"Botella-Carretero, J. I. et al. Effects of oral nutritional supplements in normally nourished or mildly undernourished geriatric patients after surgery for hip fracture: a randomized clinical trial. JPEN J. Parenter. Enter. Nutr. 32, 120\u2013128 (2008).","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"58987_CR18","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1097\/01.blo.0000224054.86625.06","volume":"451","author":"M Eneroth","year":"2006","unstructured":"Eneroth, M., Olsson, U. B. & Thorngren, K. G. Nutritional supplementation decreases hip fracture-related complications. Clin. Orthop. Relat. Res. 451, 212\u2013217 (2006).","journal-title":"Clin. Orthop. Relat. Res."},{"key":"58987_CR19","first-page":"111","volume":"24","author":"American Society of Anesthesiologists","year":"1963","unstructured":"American Society of Anesthesiologists. New classification of physical status. Anesthesiology. 24, 111 (1963).","journal-title":"Anesthesiology."},{"key":"58987_CR20","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1097\/00005373-197611000-00006","volume":"16","author":"SP Baker","year":"1976","unstructured":"Baker, S. P. & O\u2019Neill, B. The injury severity score: an update. J. Trauma. 16, 882\u2013885 (1976).","journal-title":"J. Trauma."},{"key":"58987_CR21","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1016\/j.injury.2017.01.036","volume":"48","author":"C Ihle","year":"2017","unstructured":"Ihle, C. et al. Malnutrition - an underestimated factor in the inpatient treatment of traumatology and orthopaedic patients: a prospective evaluation of 1055 patients. Injury. 48, 628\u2013636 (2017).","journal-title":"Injury."},{"key":"58987_CR22","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.arth.2015.08.028","volume":"31","author":"DD Bohl","year":"2016","unstructured":"Bohl, D. D., Shen, M. R., Kayupov, E. & Della Valle, C. J. Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty. J. Arthroplasty. 31, 15\u201321 (2016).","journal-title":"J. Arthroplasty."},{"key":"58987_CR23","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/j.jamda.2015.03.002","volume":"16","author":"S Goisser","year":"2015","unstructured":"Goisser, S. et al. Malnutrition according to mini nutritional assessment is associated with severe functional impairment in geriatric patients before and up to 6 months after hip fracture. J. Am. Med. Dir. Assoc. 16, 661\u2013667 (2015).","journal-title":"J. Am. Med. Dir. Assoc."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-58987-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-58987-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-58987-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T15:11:40Z","timestamp":1672672300000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-58987-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,6]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["58987"],"URL":"https:\/\/doi.org\/10.1038\/s41598-020-58987-4","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,6]]},"assertion":[{"value":"17 July 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 February 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"B.A.Z. has consulted for KCI Inc. USA and DepuySynthes\u00ae and received compensation. B.A.Z. has also received speaker fees from AO North America. B.A.Z. has received research grants from DepuySynthes, KCI, Department of Defense, and the Orthopaedic Trauma Association. B.A.Z. has received educational grants from Smith and Nephew Inc. and Arthrex\u00ae. He serves on the editorial board of International Orthopaedics, Journal of Orthopaedic Trauma, and Patient Safety in Surgery. None of these activities are related to the content of this article. The remaining authors declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1953"}}