Nutrition in Hip Fracture Units: Contemporary Practices in Preoperative Supplementation

Abstract

Introduction: Patients with hip fractures pose a significant burden on health services. Malnutrition, frailty, and cognitive impairment are common, and key to addressing the needs of this vulnerable patient group is nutrition optimization, including reduction in arbitrary nil by mouth (NBM) perioperative regimens. In order to understand current practices, we characterize preoperative nutrition in a regional hip fracture population. Methods: Prospective data were submitted to the National Hip Fracture Database by 6 hospitals in the north east of England over a 6-month period. Patients were stratified by preoperative nutritional intake, frailty, and cognitive function. Results: In all, 24.2% (n = 205) patients received no oral intake at all preoperatively; 15.3% of NBM patients were at risk of malnutrition; and 6.9% were malnourished at the time of assessment. Median time to surgery for NBM patients was 16.75 hours, and 6.34% of patients were fasted with no intake for >36 hours. In all, 6.5% (n = 44) of patients with an Abbreviated Mental Test Score (AMTS) of 8 or above were deemed to be at risk of malnutrition at admission, compared to 11.3% (n = 50) of patients with an AMTS of 7 or below. The NBM patients had similar mean Rockwood (4.97) and AMTS (6.51) scores to patients given oral nutrition. Conclusion: We have demonstrated contemporary preoperative nutritional practices in the management of over 800 hip fracture patients. Contrary to perception, nutrition practices vary little when stratified for age, cognition frailty, or comorbid burden. We have identified widespread prolonged NBM fasting and undersupplementation in patients sustaining hip fracture across a region. This work suggests a need to focus less on patient factors and more on systematic practices.

Impact of malnutrition in surgically repaired hip fracture patients admitted for rehabilitation in a community hospital: A cohort prospective study

“…Nutritional status in elderly patients with fracture can deteriorate during hospital stay compounded by an increased energy expenditure and requirement, owing to post-surgical repair of traumatic hip fracture [11,12]. Studies have shown that nutritional supplements prevented weight loss in both malnourished and nourished patients and this is associated with a lower risk of postsurgical complications, shorter duration of hospital stay and a significant decrease in the 1-year mortality rate[13e15].…”

Perfil clínico, nutricional e dietético de pacientes hospitalizados

“…Estes estão associados a redução das complicações provocadas pela desnutrição e mostram redução no tempo de hospitalização em até 4 dias. 11,12 O início da suplementação oral está indicado para pacientes que apresentam redução da ingestão alimentar a valores menores que 60% do valor calórico total recomendado. Considera-se, que o grupo de maior risco de baixa ingesta oral são aqueles previamente desnutridos ou em risco nutricional a partir do diagnóstico pela triagem, ou que apresentam demanda metabólica aumentada, sarcopenia, lesão de pele, oncológicos e preparo préoperatório.…”