Ashkenazi Itay, Rotman Dani, Amzalleg Nissan, Graif Nadav, Ben-Tov Tomer, Steinberg Ely
Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Geriatr Orthop Surg Rehabil. 2022 May 20;13:21514593221102252. doi: 10.1177/21514593221102252. eCollection 2022.
Malnutrition is considered a risk factor among geriatric individuals with hip fracture, affecting functional healing and recovery, increasing healthcare spending, and associated with high mortality. In this study, we sought to evaluate the clinical efficacy of oral nutritional supplements in geriatric patients undergoing surgery for hip fracture. We retrospectively analyzed data of 1625 consecutive patients who underwent fixation or arthroplasty for hip fracture in a tertiary medical center between 2017 and 2020. Patients who had no available albumin or body mass index levels were excluded. The study group is of patients who received an advanced formula in the form of an oral nutritional supplement (ONS), and the control group of patients that received no ONS. Peri- and postoperative complications, readmissions, short-term mortality, and albumin levels were compared between the 2 groups. The final cohort included 1123 patients, 298 in the study group and 825 controls, with a follow-up of at least 1-year. Provision of the advanced enriched formula was not associated with 30-day, 90-day, or 1-year mortality (P = .62, P = .52, and P = .72, respectively) or any perioperative complications, such as 30-day or 90-day readmission (P = .37 and P = .1, respectively), revision surgery of any cause (P = .35), and postoperative infection rates (P = .73). Albumin levels on admission and the minimum albumin levels during hospitalization were similar between the groups, but they were significantly higher in the study group before discharge (33.42 g/L vs. 32.79 g/L, P = .01). The use of an ONS was not associated with reduced perioperative complications or mortality, although it did affect nutritional status, as indicated by increased albumin levels, a known marker of nutritional status. While current findings do not support ONS use to minimize major postoperative complication after hip fracture surgery, further long-term study is warranted to evaluate subjective and functional outcomes associated with improved nutritional status.
营养不良被认为是老年髋部骨折患者的一个风险因素，会影响功能愈合和恢复，增加医疗支出，并与高死亡率相关。在本研究中，我们试图评估口服营养补充剂对接受髋部骨折手术的老年患者的临床疗效。我们回顾性分析了2017年至2020年期间在一家三级医疗中心连续接受髋部骨折固定术或关节置换术的1625例患者的数据。排除没有可用白蛋白或体重指数水平的患者。研究组为接受口服营养补充剂（ONS）形式的高级配方的患者，对照组为未接受ONS的患者。比较两组患者围手术期和术后并发症、再入院情况、短期死亡率和白蛋白水平。最终队列包括1123例患者，研究组298例，对照组825例，随访至少1年。提供高级强化配方与30天、90天或1年死亡率（分别为P = 0.62、P = 0.52和P = 0.72）或任何围手术期并发症无关，如30天或90天再入院（分别为P = 0.37和P = 0.1）、任何原因的翻修手术（P = 0.35）和术后感染率（P = 0.73）。两组患者入院时的白蛋白水平和住院期间的最低白蛋白水平相似，但研究组出院前的白蛋白水平显著更高（33.42 g/L对32.79 g/L，P = 0.01）。使用ONS与围手术期并发症或死亡率的降低无关，尽管它确实影响了营养状况，如白蛋白水平升高所示，白蛋白是营养状况的一个已知指标。虽然目前的研究结果不支持使用ONS来尽量减少髋部骨折手术后的主要术后并发症，但有必要进行进一步的长期研究，以评估与营养状况改善相关的主观和功能结果。
