Assessment of Nutrition and Supplementation in Patients With Hip Fractures

Abstract

Introduction:Malnutrition is common in older people, is known to interact with frailty, and is a risk factor for wound complications and poor functional outcomes postoperatively. Sustaining a hip fracture is a significant life event, often resulting in a decline in mobility and functional ability. A poor nutritional state may further impede recovery and rehabilitation, so strategies to improve perioperative nutrition are of considerable importance. We provide a review of nutritional supplement practices in this vulnerable and growing population.Method:Systematic review of preoperative oral nutritional supplementation (ONS) in hip fracture patients.Results:We identified 12 articles pertaining to this important area of perioperative care. The findings suggest postoperative ONS can improve postoperative outcomes in hip fracture patients, especially in terms of increasing total serum protein, improving nutritional status to near-optimum levels, and decreasing postoperative complications.Discussion:There is an absence of evidence specific to preoperative ONS in patients admitted following hip fracture. Literature relating to other populations is encouraging but is yet to be robustly studied. It is unclear whether these results are generalizable to the frailer hip fracture population. There is a need for studies clearly defining outcome measurement and complication assessment pertaining to preoperative ONS. The potential benefit is considerable, and this review will provide a means to inform the construction of meaningful trials in preoperative ONS of patients sustaining hip fracture.Conclusion:Oral nutritional supplementation in hip fracture patients may decrease postoperative complications while increasing elderly patient’s nutritional state to a near-optimum level. This is extrapolated from postoperative literature, however with a clear gap in research pertaining specifically to preoperative care. The need for well-constructed studies focused on the impact and assessment of early ONS in this population is transparent.

Care of Geriatric Patients with Lumbar Spine, Pelvic, and Acetabular Fractures before and after Certification as a Geriatric Trauma Center DGU®: A Retrospective Cohort Study

“…By using the MNA, a risk of malnutrition could be observed in 53.2% and manifest malnutrition in 15.6%. After the identification of patients at risk, perioperative optimization of the nutritive situation is capable of preventing complications and improving the quality of life [ 35 ].…”

Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus

“…Moreover, other evidence supports the effectiveness of nutritional screening and intervention during hospital stay [126,127]. Carbohydrate-based drinks can be used to limit the negative effect of perioperative fasting and high-calorie, high-protein supplements can be useful in obtaining adequate post-operative nutritional intake, and in reversing the catabolic state induced by HF [128,129].…”

“…It is worth highlighting that, given the high prevalence of malnutrition and anaemia, many vitamin deficiencies are frequently seen [129] and may have a significant impact on functional recovery. Indeed, vitamin B12, iron and folic acid contribute to erythropoiesis and supplements should be prescribed to promote a rise in haemoglobin after surgery and limit blood transfusion requirements.…”

Textbook process as a composite quality indicator for in-hospital hip fracture care

“…It is therefore unknown whether there is hospital variation on this indicator (unknown clinical relevancy). Oral nutritional supplementation may reduce postoperative complications, but randomized clinical trials are lacking (possibly scientifically acceptable-valid) [14].…”