Associations among malnutrition, muscle loss, and postoperative walking ability in intertrochanteric fractures: a retrospective study

Abstract

Background: Sarcopenia and malnutrition are increasing in older populations and are reported to be among the risk factors for functional impairment after hip fracture surgery. The aim of this study was to investigate the associations between loss of skeletal muscle mass, malnutrition, and postoperative walking ability in older adults with hip fractures. Methods: We retrospectively reviewed the medical records of patients who underwent surgery for intertrochanteric fractures between 2015 and 2020 at our institute. The psoas muscle index (PMI), the controlling nutritional status (CONUT) score, and the functional ambulation category (FAC) score were used for the evaluation of skeletal muscle mass, nutritional status, and walking ability. Patients were assigned to a disturbance gait (DG) or independent gait (IG) group based on walking ability 6 months after surgery. Using multivariate binomial logistic regression analysis, skeletal muscle mass, nutritional status, and other factors were used to predict the risk of being assigned to the DG group. Results: This study included 95 patients with a mean age of 85.2 years. Seventy patients were female. Low skeletal muscle mass was prevalent in 66 patients, 35 suffered from malnutrition, and 28 had both low skeletal muscle mass and malnutrition. Malnutrition and low skeletal muscle mass were significantly associated with postoperative gait disturbance (FAC<3) in the multivariate binomial logistic regression analysis. Conclusions: Both skeletal muscle loss and malnutrition before surgery were risk factors for poor walking ability after intertrochanteric fracture surgery. Preventive interventions should focus on maintaining or building skeletal muscle mass and improving nutrition in older adults who are at risk of experiencing hip fractures to optimize postoperative functional outcomes if surgery is required.

Relationship between the perioperative prognostic nutritional index and postoperative gait function in elderly hip fractures

“…The perioperative nutritional status has been associated with mid- and long-term walking function, with preoperative malnutrition in hip fracture surgery being associated with a reduced walking ability 6 months after surgery and with the Harris Hip Score 3 months after surgery [ 12 , 13 ]. On the other hand, limited information is currently available on the perioperative nutritional status and walking ability in the early postoperative period [ 14 , 26 ].…”

“…Aggressive exercise therapy under a low nutritional status or inadequate nutritional management may result in malnutrition, progressive muscle weakness, and endurance loss due to increased protein catabolism caused by energy deficiency; therefore, nutritional therapy needs to be prioritized over exercise therapy in patients with a low nutritional status [ 11 ]. Regarding the relationship between the perioperative nutritional status and motor function, preoperative malnutrition has been associated with a reduced walking ability 6 months after surgery and the Harris Hip Score from 3 months after surgery [ 12 , 13 ]. However, limited information is currently available on the relationship between the perioperative nutritional status and walking ability in the early postoperative period [ 14 ].…”