Preoperative GNRI and surgical site infection risk after total joint arthroplasty: A systematic review and meta-analysis

Surgical site infections (SSIs), including periprosthetic joint infections (PJIs), represent significant complications following total joint arthroplasty (TJA). The geriatric nutritional risk index (GNRI) serves as an objective measure of nutritional status; however, its predictive value for postoperative infections in TJA patients remains ambiguous. To address this issue, a meta-analysis was conducted alongside a systematic search of PubMed, Embase, and Web of Science. Observational studies that assessed the relationship between preoperative GNRI and postoperative SSI or PJI following TJA were included in the analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were synthesized using random-effects models to account for heterogeneity. Seven retrospective cohort studies comprising 221,810 patients were analyzed. The results indicated that a low GNRI, which suggests malnutrition, is significantly associated with an increased risk of SSI after TJA (OR = 1.59; 95% CI 1.21-2.08; I² = 81%; p < 0.001). This association persisted across both primary and revision procedures (OR = 1.52 vs. 1.65; p = 0.76) and within 30-day and 90-day follow-ups (OR = 1.58 vs. 1.56; p = 0.98). A more pronounced correlation was found in patients with severe malnutrition (GNRI < 92) compared to those with moderate risk (GNRI: 92-98; OR = 2.18 vs. 1.25; p < 0.001). Although a similar trend was observed for PJI (OR = 2.37; 95% CI 0.73-7.72; p = 0.15), this finding was based on only two studies (three datasets) and remains uncertain. Evidence regarding shoulder arthroplasty was limited; however, existing data suggested trends similar to those seen in hip and knee arthroplasty. In conclusion, preoperative malnutrition, as indicated by a low GNRI, may be associated with an elevated risk of SSIs following TJA.