Oberstar Jennifer S, Bakker Caitlin J, Sorich Megan, McCarthy Teresa
Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA.
Dr. John Archer Library & Archives, University of Regina, Regina, SK, Canada.
Geriatr Orthop Surg Rehabil. 2023 Feb 15;14:21514593231155828. doi: 10.1177/21514593231155828. eCollection 2023.
Fragility hip fracture patients are often malnourished. Nutrition supplementation may help, but it is unclear if supplementation is impactful when considering outcomes. A systematic review of literature examining perioperative nutrition status for older adults experiencing a hip fracture was performed.
We searched Medline, CAB Abstracts and Embase (Ovid); Cochrane Library (Wiley); PubMed; Scopus; Global Index Medicus; Web of Science Core Collection; SPORTDiscus (EBSCO); and clinical trial registries ClinicalTrials.gov and WHO ICTRP from inception to April 2021, incorporating terminology related to nutritional interventions, fragility fractures, and postoperative outcomes. Two investigators reviewed citations for inclusion, extracted nutrition intervention criteria, and categorized hip fragility outcomes.
Of 1792 citations, 90 articles underwent full-text screening, and 14 articles were included in the final sample. We identified nutritional interventions and 4 outcomes of interest. 8 studies (n = 649) demonstrated a mean difference of .78 days (CI .34-1.21) in length of stay (LOS) between the nutritional intervention and control groups. Rehabilitation ward stays were discussed in 2 studies demonstrating a non-statistically significant difference. 7 studies (n = 341) reported mortality rates; when pooled there was no statistically significant difference. 5 studies showed data for postoperative infections and 4 studies reported on postoperative urinary tract infections. Pooling of data found a statistically significant result (Relative Risk: .49 [.32, .75], P = .001) with low heterogeneity (I = 27%). 4 studies reported urinary tract infections (n = 140) in the intervention group and (n = 121) in the control group with a non-statistically significant result. Grip strength was only reported in two studies but pooling of the data was non-statistically significant.
This systematic review highlighted the lack of consensus regarding the type of nutrition interventions available and impact on outcomes of interest including mortality, length of stay, infections, and grip strength for fragility hip fractures in older adults.
髋部脆性骨折患者常伴有营养不良。营养补充或许有所帮助，但考虑到治疗结果时，补充营养是否有效尚不清楚。我们对有关髋部骨折老年患者围手术期营养状况的文献进行了系统综述。
我们检索了Medline、CAB文摘数据库和Embase（Ovid）；Cochrane图书馆（Wiley）；PubMed；Scopus；全球医学索引；科学网核心合集；SPORTDiscus（EBSCO）；以及临床试验注册库ClinicalTrials.gov和世界卫生组织国际临床试验平台注册库，检索时间从建库至2021年4月，纳入与营养干预、脆性骨折及术后结果相关的术语。两名研究人员对纳入的文献进行了审查，提取了营养干预标准，并对髋部脆性骨折的结果进行了分类。
在1792篇文献中，90篇文章接受了全文筛选，最终样本纳入了14篇文章。我们确定了营养干预措施和四项感兴趣的结果。8项研究（n = 649）表明，营养干预组与对照组之间的住院时间（LOS）平均相差0.78天（CI 0.34 - 1.21）。2项研究讨论了康复病房的住院时间，结果显示差异无统计学意义。7项研究（n = 341）报告了死亡率；汇总后差异无统计学意义。5项研究展示了术后感染的数据，4项研究报告了术后尿路感染的情况。数据汇总发现有统计学意义的结果（相对风险：0.49 [0.32, 0.75]，P = 0.001），异质性较低（I² = 27%）。4项研究报告了干预组（n = 140）和对照组（n = 121）的尿路感染情况，结果无统计学意义。仅有两项研究报告了握力情况，但数据汇总后差异无统计学意义。
本系统综述强调，对于老年髋部脆性骨折患者，现有营养干预措施的类型及其对包括死亡率、住院时间、感染和握力在内的感兴趣结果的影响，目前尚无共识。
