Popp Domenik, Stich-Regner Marie, Schmoelz Lukas, Silvaieh Sara, Heisinger Stephan, Nia Arastoo
Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria.
Department of Orthopedics and Traumatology, University Clinic Neunkirchen, 1090 Vienna, Austria.
Nutrients. 2024 Dec 11;16(24):4280. doi: 10.3390/nu16244280.
Hip fractures are a prevalent and serious health issue, particularly among the elderly population aged >65 years. These injuries are associated with elevated rates of postoperative complications and mortality, significantly diminishing patients' quality of life in both the short- and long-term. The prognosis for recovery is further exacerbated in individuals with signs of malnutrition. The primary objective of this study was to evaluate the predictive value of four distinct nutritional assessment scores in relation to postoperative mortality in patients undergoing surgical intervention for hip fractures at 1, 3, 6, 12, and 24 months.
This observational study included patients admitted to the Department of Traumatology at the Medical University for the surgical management of hip fractures between January 2019 and November 2021. Nutritional assessment scores were derived from a retrospective analysis of clinical data. The statistical correlation between nutritional scores and postoperative mortality outcomes was rigorously evaluated.
Logistic regression analysis revealed a statistically significant correlation ( < 0.01) between all four nutritional scores and postoperative mortality risk. The malnourished cohorts demonstrated a markedly higher risk of mortality compared to those with adequate nutritional status, as indicated by the following risk ratios: Graz Malnutrition Screening (risk ratio = 2.53-1.68), Prognostic Nutritional Index (risk ratio = 2.44-1.74), Geriatric Nutritional Risk Index (risk ratio = 2.05-1.58), and Controlling Nutritional Status (risk ratio = 2.34-1.46). Despite these findings, the receiver operating characteristic analysis yielded area under the curve (AUC) values ranging from 0.64 to 0.68, indicating limited predictive power.
Although a significant correlation existed between the evaluated nutritional scores and postoperative mortality, the predictive value of these scores was quantitatively low. No single nutritional assessment tool has emerged as a strong predictor of postoperative outcomes in this patient population. Consequently, implementation of any specific nutritional screening tool for standard assessment in patients with hip fractures is not recommended at this time. Nevertheless, given the established association between malnutrition and postoperative mortality, a comprehensive evaluation of nutritional status is advisable and further research is needed.
髋部骨折是一个普遍且严重的健康问题，尤其在65岁以上的老年人群中。这些损伤与术后并发症和死亡率的升高相关，在短期和长期内均显著降低患者的生活质量。营养不良迹象的个体恢复预后会进一步恶化。本研究的主要目的是评估四种不同营养评估评分对接受髋部骨折手术干预患者在1、3、6、12和24个月时术后死亡率的预测价值。
这项观察性研究纳入了2019年1月至2021年11月间在医科大学创伤科住院接受髋部骨折手术治疗的患者。营养评估评分来自对临床数据的回顾性分析。严格评估营养评分与术后死亡率结果之间的统计相关性。
逻辑回归分析显示，所有四种营养评分与术后死亡风险之间存在统计学显著相关性（<0.01）。与营养状况良好的人群相比，营养不良人群的死亡风险明显更高，如下风险比所示：格拉茨营养不良筛查（风险比=2.53 - 1.68）、预后营养指数（风险比=2.44 - 1.74）、老年营养风险指数（风险比=2.05 - 1.58）和控制营养状况（风险比=2.34 - 1.46）。尽管有这些发现，但受试者工作特征分析得出的曲线下面积（AUC）值在0.64至0.68之间，表明预测能力有限。
尽管评估的营养评分与术后死亡率之间存在显著相关性，但这些评分的预测价值在数量上较低。在该患者群体中，没有单一的营养评估工具成为术后结果的有力预测指标。因此，目前不建议对髋部骨折患者实施任何特定的营养筛查工具进行标准评估。然而，鉴于营养不良与术后死亡率之间已确定的关联，建议对营养状况进行全面评估，并且需要进一步研究。
