This 2014 narrative review by Cross et al. surveys how malnutrition—defined broadly to include both undernutrition and obesity—is identified and managed in elective orthopaedic patients. It asks which assessment tools and serologic thresholds best predict surgical site infection risk in spine surgery and total joint arthroplasty, and how preoperative optimization should be structured.
When planning elective spine or joint arthroplasty, routinely check albumin, total lymphocyte count, and transferrin—if values fall below threshold (albumin <3.5 g/dL, TLC <1,500 cells/mm³, transferrin <200 mg/dL), refer for nutritional consultation and consider delaying surgery; in obese diabetic patients especially, recognize that the combination carries multiplicative infection risk and that a 5% I&D salvage rate in malnourished patients makes prevention far more valuable than rescue.
This 2014 narrative review by Cross et al. surveys how malnutrition—defined broadly to include both undernutrition and obesity—is identified and managed in elective orthopaedic patients. It asks which assessment tools and serologic thresholds best predict surgical site infection risk in spine surgery and total joint arthroplasty, and how preoperative optimization should be structured.
When planning elective spine or joint arthroplasty, routinely check albumin, total lymphocyte count, and transferrin—if values fall below threshold (albumin <3.5 g/dL, TLC <1,500 cells/mm³, transferrin <200 mg/dL), refer for nutritional consultation and consider delaying surgery; in obese diabetic patients especially, recognize that the combination carries multiplicative infection risk and that a 5% I&D salvage rate in malnourished patients makes prevention far more valuable than rescue.