The Influence of Malnutrition Measured by Hypalbuminemia and Body Mass Index on the Outcome of Geriatric Patients with a Fracture of the Proximal Femur

Abstract

Background and Objectives: Fractures of the proximal femur are a life-changing and life-threatening event for older people. Concomitant malnutrition has been described as an independent risk factor for complications and mortality. Therefore, we examined the influence of albumin and body mass index (BMI) as parameters for the nutritional state on the outcome after geriatric hip fracture surgery. Materials and Methods: Data were retrospectively collected from hospital information systems, and complications and all other parameters were obtained from patient charts. We included patients aged 70 years or above with a fracture of the proximal femur. We excluded periprosthetic and peri-implant fractures and patients with a missing BMI or albumin value. Results: Patients with a BMI below 20 kg/m2 were more likely to be female but did not differ from the normal BMI group in terms of baseline parameters. Patients with hypoalbuminemia had a higher ASA grade and Charlson Comorbidity Index, as well as a lower hemoglobin value and prothrombin time compared to those with normal albumin values and low BMI. Hypoalbuminemia was associated with significantly increased rates of complications (57.9% vs. 46.7%, p = 0.04) and mortality (10.3% vs. 4.1%, p = 0.02). Blood loss and transfusion rates were higher in the hypoalbuminemia group. Patients with a BMI below 20 kg/m2 had a higher risk of intraoperative cardiac arrest (2.6% vs. 0.4%, p = 0.05) but did not show higher mortality rates than patients with a BMI above 20 kg/m2. However, the outcome parameter could not be confirmed in the regression analysis. Conclusions: Hypoalbuminemia might be an indicator for more vulnerable patients with a compromised hemoglobin value, prothrombin time, and ASA grade. Therefore, it is also associated with higher mortality and postoperative complications. However, hypoalbuminemia was not an independent predictor for mortality or postoperative complications, but low albumin values were associated with a higher CCI and ASA grade than in patients with a BMI below 20 kg/m2.

A Prospective, Observational Study of the Effect of a High-Calorie, High-Protein Oral Nutritional Supplement with HMB in an Old and Malnourished or at-Risk-of-Malnutrition Population with Hip Fractures: A FracNut Study

“…In addition, vitamin D supplementation in this population has not been associated with a clinically significant improvement in their QoL [ 46 ]. On the contrary, low serum albumin levels have been associated with high mortality [ 38 , 47 ] and postoperative complications [ 48 ] in older patients after hip fracture surgery. An association has also been found between a low lymphocyte count [ 38 ], high neutrophil-to-lymphocyte ratio [ 49 ], and high platelet-to-lymphocyte ratio [ 50 ] with mortality in older patients after hip fractures [ 51 ].…”

The Nomogram Model and Factors for the Postoperative Mortality of Elderly Patients with Femoral Neck Fracture Undergoing Artificial Hip Arthroplasty: A Single‐Institution 6‐Year Experience

“…Although it has been reported in the literature that hypoalbuminemia is not an independent predictive factor for death and postoperative complications, hypoalbuminemic patients had higher ASA grade and Charlson co‐morbidity index, as well as lower HB and PT. Thus, hypoalbuminemia was also associated with complications and the death of elderly patients 36 . Therefore, we recommend the following for elderly patients: comprehensively evaluate the nutritional risk, enhance the nutritional management and provide nutritional support for elderly patients with femoral neck fractures who have poor nutritional status before surgery; and preoperatively, address severe anemia and postoperative hypoproteinemia to improve postoperative recovery and reduce the likelihood of a poor prognosis for elderly patients.…”

Predictors of one-year mortality following hip fracture surgery in elderly

“…RDW is included in CBC, which is readily available and inexpensive. According to several studies, high RDW levels are closely linked to mortality ( Laulund et al, 2012 , p. 6; Lv et al, 2016 ; Yin et al, 2016 ; Pass et al, 2022 ). A retrospective study of 1574 elderly patients who underwent hip fracture surgery was conducted.…”

“…Moreover, RDW is also used to predict the mortality of hip fractures alone or in combination with other factors ( Garbharran et al, 2013 ; Yin et al, 2016 ; Hamdan et al, 2021 ; Marom et al, 2022 ). In numerous studies, low serum albumin levels have been found to negatively correlate with hip fracture mortality ( Pimlott et al, 2011 ; Laulund et al, 2012 ; Pass et al, 2022 ).…”