JSES - 2026-07-26 - Journal Article
Lower Postoperative Geriatric Nutritional Risk Index Is Associated with Increased Complications and Reoperations Following Shoulder Arthroplasty.
Polam V, Stokes L, Sauvanell YM, Gosselin M, Nahr A, Denard PJ
Topics
Key Takeaway
Postoperative GNRI <109 confers a 13.19-fold increased odds of any complication and 6.21-fold increased odds of reoperation following TSA, despite equivalent long-term PROs and ROM.
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Summary
This retrospective cohort study evaluated whether postoperative GNRI (calculated from serum albumin and body weight) predicts complications and PROs after primary anatomic or reverse TSA. Patients with postoperative GNRI <109 (28.6% of cohort) had complication rates of 18.0% vs 2.4% and reoperation rates of 10.0% vs 2.4% compared to nutritionally normal patients. On multivariable logistic regression adjusted for age and sex, GNRI <109 independently predicted complications (OR 13.19) and reoperation (OR 6.21), while ASES, SANE, VAS pain, and VR-12 scores were equivalent between groups at final follow-up.
Key Limitation
The retrospective design with a single-center cohort of 175 patients limits causal inference and generalizability, and the study cannot determine whether correcting postoperative nutritional deficiency reduces complication rates.
Original Abstract
BACKGROUND
Nutritional status influences postoperative recovery and complication risk across orthopedic procedures, yet its role in shoulder arthroplasty remains poorly defined. The purpose of this study was to evaluate whether postoperative Geriatric Nutritional Risk Index (GNRI) is associated with complications and outcomes following total shoulder arthroplasty (TSA).
METHODS
A retrospective comparative study was performed of patients who underwent primary anatomic or reverse TSA with minimum 2-year follow-up. Pre- and postoperative GNRI values were calculated from serum albumin and body weight. Patients were classified as nutritionally normal (GNRI ≥109) or at risk (GNRI <109). Complications, reoperations, range of motion (ROM) and patient-reported outcomes (PROs) (ASES, VAS pain, WOOS, SANE), and expectation-based patient satisfaction were compared between groups. Logistic regression assessed GNRI as an independent predictor of complications after adjustment for age, BMI, diagnosis, and comorbidities.
RESULTS
A total of 175 patients met the study criteria, of which 50 (28.6%) were classified as nutritionally at risk postoperatively. The at-risk group had a greater postoperative decline in GNRI (-4.9 ± 10.6 vs +0.7 ± 5.4; p < 0.001). Improvements in range of motion, patient-reported outcomes, MCID attainment, expectations, and satisfaction were similar between GNRI groups at final follow-up (all p > 0.05). Postoperative complications were more frequent among patients with GNRI <109, including any complication (18.0% vs 2.4%; p = 0.001), reoperation (10.0% vs 2.4%; p = 0.044), and non-surgical medical complications (8.0% vs 0.0%; p = 0.006). On multivariable analysis adjusted for age and sex, postoperative GNRI <109 was independently associated with increased odds of any complication (OR 13.19; p < 0.001) and reoperation (OR 6.21; p = 0.034). No independent associations were observed between postoperative GNRI <109 and ASES, SANE, VAS pain, or VR-12 mental or physical component scores (all p ≥ 0.05).
CONCLUSION
Lower postoperative GNRI was strongly associated with increased complication and reoperation rates following TSA, with GNRI <109 conferring more than a 13-fold higher odds of any complication and a six-fold higher odds of reoperation. Despite these findings, long-term patient-reported outcomes and range of motion were similar between nutritional groups. GNRI screening or monitoring may identify patients at risk for complication following TSA.
STUDY DESIGN
Level III, Retrospective Cohort Comparison, Prognosis Study.