Poor nutritional status correlates with mortality and worse postoperative outcomes in patients with femoral neck fractures

Abstract

Aims Patients who sustain neck of femur fractures are at high risk of malnutrition. Our intention was to assess to what extent malnutrition was associated with worse patient outcomes. Methods A total of 1,199 patients with femoral neck fractures presented to a large UK teaching hospital over a three-year period. All patients had nutritional assessments performed using the Malnutrition Universal Screening Tool (MUST). Malnutrition risk was compared to mortality, length of hospital stay, and discharge destination using logistic regression. Adjustments were made for covariates to identify whether malnutrition risk independently affected these outcomes. Results Inpatient mortality was 5.2% (35/678) in the group at low risk of malnutrition, 11.3% (46/408) in the medium-risk group, and 17.7% (20/113) in the high-risk group. Multivariate analysis showed each categorical increase in malnutrition risk independently predicted inpatient mortality with an odds ratio (OR) of 1.59 (95% confidence interval (CI) 1.14 to 2.21; p = 0.006). An increased mortality rate persisted at 120 days post-injury (OR 1.64, 95% CI 1.20 to 2.22; p = 0.002). There was a stepwise increase in the proportion of patients discharged to a residence offering a greater level of supported living. Multivariate analysis produced an OR of 1.34 (95% CI 1.03 to 1.75; p = 0.030) for each category of MUST score. Median length of hospital stay increased with a worse MUST score: 13.9 days (interquartile range (IQR) 8.2 to 23.8) in the low-risk group; 16.6 days (IQR 9.0 to 31.5) in the medium-risk group; and 22.8 days (IQR 10.1 to 41.1) in the high-risk group. Adjustment for covariates revealed a partial correlation coefficient of 0.072 (p = 0.008). Conclusion A higher risk of malnutrition independently predicted increased mortality, length of hospital stay, and discharge to a residence offering greater supported living after femoral neck fracture. Cite this article: Bone Joint J 2021;103-B(1):164–169.

Short‐Term Outcomes of Enhanced Recovery after Surgery (ERAS) for Ankle Fracture Patients: A Single‐Center Retrospective Cohort Study

“…The possible mechanisms and advantages of the ERAS protocol are described as follows. First, individual conditions of participation are considered, and a patient‐center approach will optimize the management 33 . Second, proper reduction and fixation under emergent anesthesia will allow for early mobility and pain relief 34 .…”

“…First, individual conditions of participation are considered, and a patient‐center approach will optimize the management. 33 Second, proper reduction and fixation under emergent anesthesia will allow for early mobility and pain relief. 34 Moreover, the selection of anesthesia such as peripheral nerve blocks might also help to improve postoperative pain relief.…”

Prognostic Factors for Mortality, Activity of Daily Living, and Quality of Life in Taiwanese Older Patients within 1 Year Following Hip Fracture Surgery

“…However, only the length of postoperative follow-up time, serum albumin level, SPMSQ score, and handgrip strength were found to be significant in the GEE multivariate analysis model with multiple imputation. Dementia, delirium, and malnutrition are also critical risk factors for poor postoperative outcomes following hip fracture [36,37]. Handgrip strength is assessed noninvasively and is thus convenient for repetitive measurements.…”

Short-term outcomes of enhanced recovery after surgery (ERAS) for ankle fracture: a single-center retrospective cohort study

“…Possible mechanisms and advantages of ERAS protocol are described as follows. First of all, individual conditions of participation were considered, and a patient-center approach would optimize the managements [29]. Secondly, proper reduction and xation under emergent anesthesia obtained early mobility and pain relief [30].…”