Association between early postoperative nutritional supplement utilisation and length of stay in malnourished hip fracture patients.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Informations de copyright

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declarations of interest PEW has received grant funding related to this work from National Institutes of Health, Canadian Institutes of Health Research, Abbott, Baxter, Fresenius, Nutricia, and Takeda. PEW serves as a consultant to Abbott, Fresenius, Baxter, Nutricia, and Takeda for research related to nutrition in surgery and ICU care; has received unrestricted gift donation for surgical and critical care nutrition research from Musclesound and Cosmed; and has received honoraria or travel expenses for CME lectures on improving nutrition care in surgery and critical care from Abbott, Baxter, and Nutricia. DGAW receives support from NIH T32 Anesthesiology Department Research Training Grant and ASPEN Rhoads Research Foundation. SS, BAC and RH are employees and stockholders of Abbott. The other authors have no conflicts of interest to report.