Undernourished Patients With Hip Fracture: Poor Outcome is Not Due to Excess Infections

Abstract

Background: Undernourished hip fracture patients have poorer outcomes for undetermined reasons. We postulated that an immune deficit from malnutrition could lead to excess infections in these patients. Objective: To document the nutritional status (body mass index, BMI), infection rates and outcome in a group of patients with hip fracture. Subjects: One hundred consecutive cases, after excluding nursing home residents and those with end‐stage or malignant disease. Results: Low BMI was common and was associated with greater age, presence of dementia and falling indoors. Patients with low BMI had significantly poorer functional outcomes, greater mortality and nursing home admission rates. Infections were not more common in those with low BMI. An apparent association between poor outcome and the presence of infection in those with low BMI was not confirmed by multiple logistic regression analysis. Conclusions: Significant undernutrition was common and was associated with poorer outcomes in patients with hip fracture. This did not appear to be due to either an excess of infections or an adverse response to infection.

A trial assessing N-3 as treatment for injury-induced cachexia (ATLANTIC trial): does a moderate dose fish oil intervention improve outcomes in older adults recovering from hip fracture?

“…There is an extremely high prevalence (up to 63%) of pre-existing malnutrition amongst PFF patients on acute admission to hospital [ 9 , 10 ]. Malnutrition in this setting has consistently been demonstrated to lead to adverse patient outcomes through increasing the risk of postoperative complications [ 11 ], limiting participation in rehabilitation and delaying optimal recovery of ambulatory status and independence [ 12 , 13 ]. Moreover, there is a marked decline in nutritional status in these patients throughout the acute admission, commencing within one week of admission and continuing for six to twelve weeks post surgery [ 14 , 15 ].…”