Frailty and Malnutrition Are Associated With Inpatient Postoperative Complications and Mortality in Hip Fracture Patients

Jacob M Wilson; Adam R Boissonneault; Andrew M Schwartz; Christopher A Staley; Mara L Schenker

doi:10.1097/BOT.0000000000001386

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Frailty and Malnutrition Are Associated With Inpatient Postoperative Complications and Mortality in Hip Fracture Patients

Journal article

Peer reviewed

Frailty and Malnutrition Are Associated With Inpatient Postoperative Complications and Mortality in Hip Fracture Patients

Jacob M Wilson, Adam R Boissonneault, Andrew M Schwartz, Christopher A Staley and Mara L Schenker

Journal of orthopaedic trauma, Vol.33(3), pp.143-148

03/2019

DOI: 10.1097/BOT.0000000000001386

PMID: 30570618

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Abstract

To examine the relationship of nutrition parameters with the modified frailty index (mFI) and postoperative complications in hip fracture patients. Retrospective observational cohort study. Urban, American College of Surgeons-Verified, Level-1, Trauma Center. Three hundred seventy-seven consecutive patients with isolated hip fractures. N/A. On admission, albumin and total lymphocyte count (TLC) levels and complication data were collected. Additionally, mFI scores were calculated. Statistical analysis was then used to analyze the association between frailty, malnutrition, and postoperative complications. Overall, 62.6% and 17.5% of patients were malnourished as defined by TLC of <1500 cells per cubic millimeter and albumin of <3.5 g/dL, respectively. Both TLC (P = 0.024; r = -0.12) and albumin (P < 0.001; r = -0.23) weakly correlated with frailty. Combining malnutrition and frailty revealed predictive synergy. Albumin of <3.5 g/dL and mFI of ≥0.18 in the same patient resulted in a positive predictive value of 69% and a likelihood ratio of 4 (2.15-7.43) for postoperative complications. Similarly, the combination of hypoalbuminemia and frailty resulted in a positive predictive value of 23.3% and likelihood ratio of 8.52 (P < 0.001) for mortality. When patients are frail and malnourished, there is a risk elevation beyond that of frailty or malnutrition in isolation. This high-risk cohort can be easily identified at admission with routine laboratory values and clinical history. There is an opportunity to improve outcomes in frail hip fracture patients because malnutrition represents a potentially modifiable risk factor. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Aged

Aged, 80 and over

Female

Fracture Fixation - adverse effects

Fracture Fixation - mortality

Frailty - blood

Frailty - complications

Frailty - diagnosis

Frailty - mortality

Hip Fractures - blood

Hip Fractures - complications

Hip Fractures - mortality

Hip Fractures - surgery

Humans

Lymphocyte Count

Male

Malnutrition - blood

Malnutrition - complications

Malnutrition - diagnosis

Malnutrition - mortality

Middle Aged

Postoperative Complications - mortality

Predictive Value of Tests

Retrospective Studies

Risk Assessment

Risk Factors

Serum Albumin - analysis

Severity of Illness Index

Details

Title: Subtitle: Frailty and Malnutrition Are Associated With Inpatient Postoperative Complications and Mortality in Hip Fracture Patients
Creators: Jacob M Wilson - Emory University
Adam R Boissonneault
Andrew M Schwartz
Christopher A Staley
Mara L Schenker
Resource Type: Journal article
Publication Details: Journal of orthopaedic trauma, Vol.33(3), pp.143-148
DOI: 10.1097/BOT.0000000000001386
PMID: 30570618
ISSN: 0890-5339
eISSN: 1531-2291
Language: English
Date published: 03/2019
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984303971102771

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