Predictive Validity of Mortality after Surgically Treated Proximal Femur Fractures Based on Four Nutrition Scores—A Retrospective Data Analysis

Abstract

Background: Hip fractures are becoming a growing concern due to an aging population. The high costs to the healthcare system and far-reaching consequences for those affected, including a loss of independence and increased mortality rates, make this issue important. Poor nutritional status is a common problem among geriatric patients and is associated with a worse prognosis. Nutritional screening tools can help identify high-risk patients and enable individualized care to improve survival rates. Material and methods: This retrospective study investigates four nutritional scores and laboratory parameters’ predictive significance concerning postoperative mortality after surgical treatment of proximal femur fractures at 1, 3, 6, and 12 month/s for patients over 60 years using the chi-square test, Cox regression analysis, and receiver operating characteristics (ROC). The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines were used as part of the screening of the respective nutritional status of the patients, in particular to filter out malnutrition. Results: A total of 1080 patients were included in this study, whereas 8.05% suffered from malnutrition, defined as a body mass index (BMI) below 18.5 kg/m2. The Mini Nutritional Assessment (MNA) screening tool identified the highest proportion of malnourished patients at 14.54%. A total of 36.39% of patients were at risk of malnutrition according to three nutrition scores, with MNA providing the most significant proportion at 41.20%. Patients identified as malnourished had a higher mortality rate, and MNA screening was the only tool to show a significant correlation with postoperative mortality in all survey intervals. The MNA presented the best predictive significance among the screening tools, with a maximum area under the curve (AUC) of 0.7 at 12 month postoperatively. Conclusions: MNA screening has a solid correlation and predictive significance regarding postoperative mortality—therefore routine implementation of this screening in orthopedic/traumatology wards is recommended. Moreover, nutritional substitution therapy can offer a relatively inexpensive and easy-to-implement measure. The Graz malnutrition screening (GMS) shows moderate predictive power and could be considered as an alternative for patients under 60 years of age. A higher albumin level is associated with improved survival probability, but cannot be indicative of nutritional status.

Malnutrition-Related Health Outcomes in Older Adults with Hip Fractures: A Systematic Review and Meta-Analysis

“…At the end of the selection process, 36 studies were eligible for inclusion in the systematic review [25,28,30,31,33,34,36,[38][39][40][41][43][44][45][46][48][49][50][51]53,54,56,[58][59][60][61]64,[67][68][69][70][71][72][73]75,76] and 14 studies were eligible for inclusion in the meta-analysis [34,36,39,43,49,51,53,56,64,[67][68][69][70]72].…”

“…The general characteristics of the 14 studies included in the meta-analysis evaluating the association between malnutrition and health outcome in older adults with hip fractures and are shown in Table 1. Studies were conducted in Finland [34,43,49], the Netherlands [36], Italy [39], China [51,64,68,70], Taiwan [53], United States [56], Japan [67], Austria [69], and Spain [72]. There were 11 cohort studies [34,36,39,43,49,51,56,64,68,70,72] and 3 were casecontrol studies [53,67,69].…”

“…Studies were conducted in Finland [34,43,49], the Netherlands [36], Italy [39], China [51,64,68,70], Taiwan [53], United States [56], Japan [67], Austria [69], and Spain [72]. There were 11 cohort studies [34,36,39,43,49,51,56,64,68,70,72] and 3 were casecontrol studies [53,67,69]. These studies were published between 2015 and 2023.…”

“…These studies were published between 2015 and 2023. All of these 14 studies were conducted in people aged ≥ 65 years old: women were more involved than men; regarding age, 5 studies [36,56,[67][68][69] examined patients > 75 years old.…”

Direct Anterior Approach Total Hip Arthroplasty for Femoral Neck Fractures in the Lateral Position

“…With the aging of the population, the number of patients with hip fractures is gradually increasing, and femoral neck fracture is one of the common fractures of the hip. 1 , 2 Patients will experience a significant reduction in quality of life after fracture, with high rates of disability and mortality. 3 , 4 Total hip arthroplasty (THA) is a common surgical procedure for the treatment of femoral neck fracture in the elderly, and its surgical approaches mainly include posterolateral approach (PLA) and direct anterior approach (DAA).…”