CAPER Unit, Department of Anesthesiology, USA; Duke Clinical Research Institute, Durham, NC, USA.
CAPER Unit, Department of Anesthesiology, USA.
Br J Anaesth. 2021 Mar;126(3):730-737. doi: 10.1016/j.bja.2020.12.026. Epub 2021 Jan 28.
Malnutrition in older hip fracture patients is associated with increased complication rates and mortality. As postoperative nutrition delivery is essential to surgical recovery, postoperative nutritional supplements including oral nutritional supplements or tube feeding formulas can improve postoperative outcomes in malnourished hip/femur fracture patients. The association between early postoperative nutritional supplements utilisation and hospital length of stay was assessed in malnourished hip/femur fracture patients.
This is a retrospective cohort study of malnourished hip/femur fracture patients undergoing surgery from 2008 to 2018. Patients were identified through International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes and nutritional supplement utilisation via hospital charge codes. The primary outcome was hospital length of stay. Secondary outcomes included infectious complications, hospital mortality, ICU admission, and costs. Propensity matching (1:1) and univariable analysis were performed.
Overall, 160 151 hip/femur fracture surgeries were identified with a coded-malnutrition prevalence of 8.7%. Early postoperative nutritional supplementation (by hospital day 1) occurred in 1.9% of all patients and only 4.9% of malnourished patients. Propensity score matching demonstrated early nutritional supplements were associated with significantly shorter length of stay (5.8 [6.6] days vs 7.6 [5.8] days; P<0.001) without increasing hospital costs. No association was observed between early nutritional supplementation and secondary outcomes.
Malnutrition is underdiagnosed in hip/femur fracture patients, and nutritional supplementation is underutilised. Early nutritional supplementation was associated with a significantly shorter hospital stay without an increase in costs. Nutritional supplementation in malnourished hip/femur fracture patients could serve as a key target for perioperative quality improvement.
老年髋部骨折患者营养不良与并发症发生率和死亡率增加有关。由于术后营养供给对手术恢复至关重要，因此术后营养补充剂，包括口服营养补充剂或管饲配方，可以改善营养不良的髋/股骨骨折患者的术后结局。本研究评估了髋/股骨骨折术后早期营养补充剂的使用与住院时间的关系。
这是一项回顾性队列研究，纳入了 2008 年至 2018 年期间接受手术治疗的营养不良的髋/股骨骨折患者。通过国际疾病分类第 9 版（ICD-9）和第 10 版（ICD-10）代码以及通过住院费用代码识别营养补充剂的使用情况。主要结局为住院时间。次要结局包括感染并发症、住院死亡率、入住重症监护病房和费用。进行了倾向评分匹配（1:1）和单变量分析。
总体而言，共确定了 160151 例髋/股骨骨折手术，编码营养不良的患病率为 8.7%。所有患者中有 1.9%和仅 4.9%的营养不良患者在术后早期接受了营养补充剂。倾向评分匹配表明，早期营养补充剂与住院时间显著缩短相关（5.8[6.6]天比 7.6[5.8]天；P<0.001），而不增加住院费用。早期营养补充与次要结局之间未观察到相关性。
髋/股骨骨折患者中营养不良的诊断不足，营养补充的应用不足。早期营养补充与住院时间显著缩短相关，而不增加成本。在营养不良的髋/股骨骨折患者中进行营养补充可能成为围手术期质量改进的关键目标。
