What Postoperative Nutritional Interventions Lead to Better Outcomes in Fragility Hip Fractures? A Systematic Review

Overview

Journal Geriatr Orthop Surg Rehabil

Publisher Sage Publications

Specialty Geriatrics

Date 2023 Feb 23

PMID 36817328

Authors

Jennifer S Oberstar

Caitlin J Bakker

Megan Sorich

Teresa McCarthy

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Citing Articles

Do Hypoalbuminaemia Increase the Risk of Surgical Site Infection in Neck of Femur Fracture Patients: A Systematic Review and Meta-Analysis.

Mostafa O, Al-Allaf O, Tahir M, Hossain F, Blackwell J Cureus. 2024; 16(5):e61372.

PMID: 38817798 PMC: 11139050. DOI: 10.7759/cureus.61372.

References

Armijo-Olivo S, Stiles C, Hagen N, Biondo P, Cummings G . Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract. 2010; 18(1):12-8. DOI: 10.1111/j.1365-2753.2010.01516.x. View

Cameron I, Kurrle S, Uy C, Lockwood K, Au L, Schaafsma F . Effectiveness of oral nutritional supplementation for older women after a fracture: rationale, design and study of the feasibility of a randomized controlled study. BMC Geriatr. 2011; 11:32. PMC: 3127759. DOI: 10.1186/1471-2318-11-32. View

Malafarina V, Uriz-Otano F, Malafarina C, Martinez J, Zulet M . Effectiveness of nutritional supplementation on sarcopenia and recovery in hip fracture patients. A multi-centre randomized trial. Maturitas. 2017; 101:42-50. DOI: 10.1016/j.maturitas.2017.04.010. View

Fabian E, Gerstorfer I, Thaler H, Stundner H, Biswas P, Elmadfa I . Nutritional supplementation affects postoperative oxidative stress and duration of hospitalization in patients with hip fracture. Wien Klin Wochenschr. 2011; 123(3-4):88-93. DOI: 10.1007/s00508-010-1519-6. View

Bachrach-Lindstrom M, Johansson T, Unosson M, Ek A, Wahlstrom O . Nutritional status and functional capacity after femoral neck fractures: a prospective randomized one-year follow-up study. Aging (Milano). 2000; 12(5):366-74. DOI: 10.1007/BF03339862. View

Botella-Carretero J, Iglesias B, Balsa J, Arrieta F, Zamarron I, Vazquez C . Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: a randomized clinical trial. Clin Nutr. 2010; 29(5):574-9. DOI: 10.1016/j.clnu.2010.01.012. View

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A . Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016; 5(1):210. PMC: 5139140. DOI: 10.1186/s13643-016-0384-4. View

Gunnarsson A, Lonn K, Gunningberg L . Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation?. J Clin Nurs. 2009; 18(9):1325-33. DOI: 10.1111/j.1365-2702.2008.02673.x. View

Thomas B, Ciliska D, Dobbins M, Micucci S . A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evid Based Nurs. 2006; 1(3):176-84. DOI: 10.1111/j.1524-475X.2004.04006.x. View

10.

Williams D, Ohnuma T, Haines K, Krishnamoorthy V, Raghunathan K, Sulo S . Association between early postoperative nutritional supplement utilisation and length of stay in malnourished hip fracture patients. Br J Anaesth. 2021; 126(3):730-737. DOI: 10.1016/j.bja.2020.12.026. View

11.

Sullivan D, Nelson C, Klimberg V, Bopp M . Nightly enteral nutrition support of elderly hip fracture patients: a pilot study. J Am Coll Nutr. 2005; 23(6):683-91. DOI: 10.1080/07315724.2004.10719410. View

12.

Espaulella J, Guyer H, Castells M, Pladevall M . Nutritional supplementation of elderly hip fracture patients. A randomized, double-blind, placebo-controlled trial. Age Ageing. 2000; 29(5):425-31. DOI: 10.1093/ageing/29.5.425. View

13.

Myint M, Wu J, Wong E, Chan S, To T, Chau M . Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. Age Ageing. 2012; 42(1):39-45. DOI: 10.1093/ageing/afs078. View

14.

Anbar R, Beloosesky Y, Cohen J, Madar Z, Weiss A, Theilla M . Tight calorie control in geriatric patients following hip fracture decreases complications: a randomized, controlled study. Clin Nutr. 2013; 33(1):23-8. DOI: 10.1016/j.clnu.2013.03.005. View

15.

Veronese N, Maggi S . Epidemiology and social costs of hip fracture. Injury. 2018; 49(8):1458-1460. DOI: 10.1016/j.injury.2018.04.015. View

16.

Bruce D, Laurance I, McGuiness M, Ridley M, Goldswain P . Nutritional supplements after hip fracture: poor compliance limits effectiveness. Clin Nutr. 2003; 22(5):497-500. DOI: 10.1016/s0261-5614(03)00050-5. View

17.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

18.

Tidermark J, Ponzer S, Carlsson P, Soderqvist A, Brismar K, Tengstrand B . Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures. Clin Nutr. 2004; 23(4):587-96. DOI: 10.1016/j.clnu.2003.10.006. View

19.

Avenell A, Smith T, Curtain J, Mak J, Myint P . Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev. 2016; 11:CD001880. PMC: 6464805. DOI: 10.1002/14651858.CD001880.pub6. View

20.

Adeyemi A, Delhougne G . Incidence and Economic Burden of Intertrochanteric Fracture: A Medicare Claims Database Analysis. JB JS Open Access. 2019; 4(1):e0045. PMC: 6510469. DOI: 10.2106/JBJS.OA.18.00045. View