Effect of nutritional status before femoral neck fracture surgery on postoperative outcomes: a retrospective study

Abstract Background Although nutritional status is crucial in gait recovery after femoral neck fracture surgery, the relationship between preoperative nutritional status and postoperative outcomes remains unknown. This study examined the effects of preoperative nutritional status on postoperative outcomes in patients undergoing femoral neck fracture surgery. Methods Data regarding the joints of 137 patients (29 men, 108 women) who underwent bipolar hemiarthroplasty for femoral neck fractures at our hospital from January 2015 to December 2019 were retrospectively examined. The Geriatric Nutritional Risk Index (GNRI), an index of nutritional status, was used to classify patients into two groups: a normal group (GNRI ≥92; n = 62) and an undernourished group (GNRI < 92; n = 75). The study endpoints included age at surgery, sex, Mini Mental State Examination (MMSE), American Society of Anesthesiologists Physical Status (ASA) classification, preoperative waiting period, intraoperative blood loss, surgery time, perioperative hemoglobin levels, blood transfusion rate, complication rate, 6-month mortality rate, transfer rate, percentage of patients unable to walk at discharge or transfer, and inability to walk 6 months postoperatively. Results The patients in the undernourished group was significantly older at surgery (p < 0.01) and had a lower perioperative hemoglobin levels (p < 0.01), a higher blood transfusion rate (p < 0.01), a lower MMSE (p < 0.01), a longer preoperative waiting period (p < 0.05), a higher transfer rate (p < 0.05), were more likely to be unable to walk 6 months postoperatively (p < 0.01), a higher complication rate (p < 0.05), and a higher 6-month mortality rate (p < 0.01) than the normal group. Patients in the undernourished group had worse rates of postoperative complications, transfer, mortality, and inability to walk 6-month after surgery than those in the normal group. Conclusions A poor nutritional status affects the gait function and systemic condition of patients undergoing femoral neck fracture surgery; therefore, early nutritional interventions may reduce mortality rates and shorten rehabilitation. These results suggest that the GNRI effectively predicts postoperative complications, mortality, and gait function.

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Effect of nutritional status before femoral neck fracture surgery on postoperative outcomes: a retrospective study

10.21203/rs.3.rs-902439/v1 ◽

2021 ◽

Author(s):

Katsuya Yokoyama ◽

Taku Ukai ◽

Masahiko Watanabe

Keyword(s):

Femoral Neck ◽

Nutritional Status ◽

Femoral Neck Fracture ◽

Transfer Rate ◽

Normal Group ◽

Postoperative Outcomes ◽

Transfusion Rate ◽

Neck Fracture ◽

Gait Function ◽

Fracture Surgery

Abstract Background Although nutritional status is crucial in gait recovery after femoral neck fracture surgery, the relationship between preoperative nutritional status and postoperative outcomes remains unknown. This study examined the effects of preoperative nutritional status on postoperative outcomes in patients undergoing femoral neck fracture surgery. Methods Data regarding the joints of 137 patients (29 men, 108 women) who underwent bipolar hemiarthroplasty for femoral neck fractures at our hospital from January 2015 to December 2019 were retrospectively examined. The Geriatric Nutritional Risk Index (GNRI), an index of nutritional status, was used to classify patients into two groups: a normal group (GNRI ≥ 92; n = 62) and an undernourished group (GNRI < 92; n = 75). The study endpoints included age at surgery, sex, preoperative waiting period, intraoperative blood loss, surgery time, blood transfusion rate, complication rate, 6-month mortality rate, transfer rate, and percentage of patients unable to walk at discharge or transfer. Results The undernourished group was significantly older at surgery (83.3 ± 6.9 years versus [vs.] 79.6 ± 8.8 years; p < 0.01) and had a higher blood transfusion rate (41.3% [31/75] vs. 12.9% [8/62]; p < 0.01), a longer preoperative waiting period (5.5 ± 5.8 days vs. 3.9 ± 2.6 days; p < 0.05), a higher transfer rate (24% [18/75] vs. 9.7% [6/62]; p < 0.05), a higher complication rate (52% [39/75] vs. 35.5% [22/62]; p < 0.05), and a higher 6-month mortality rate (13.3% [10/75] vs. 0% [0/62]; p < 0.01) than the normal group. The most common complication was pneumonia. Patients in the undernourished group had worse rates of postoperative complications, transfer, and mortality than the normal group. Conclusions A poor nutritional status affects the gait function and systemic condition of patients undergoing femoral neck fracture surgery; therefore, early nutritional interventions may reduce mortality rates and shorten rehabilitation. These results suggest that the GNRI effectively predicts postoperative complications, mortality, and gait function.

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Intra-Articular Tranexamic Acid Injection During the Hip Hemi-Arthroplasty in Elderly Patients: A Retrospective Study

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318803851 ◽

2018 ◽

Vol 9 ◽

pp. 215145931880385 ◽

Cited By ~ 3

Author(s):

Wei Liu ◽

Huangdong Hui ◽

Yunhai Zhang ◽

Weilong Lin ◽

Yongqian Fan

Keyword(s):

Logistic Regression ◽

Femoral Neck ◽

Blood Loss ◽

Elderly Patients ◽

Tranexamic Acid ◽

Femoral Neck Fracture ◽

Mortality Rates ◽

Transfusion Rate ◽

Neck Fracture ◽

Hemi Arthroplasty

Introduction: The objective was to evaluate the safety and efficacy of intra-articular injection of tranexamic acid (TXA) in patients between 80 and 100 years of age with femoral neck fracture undergoing hip hemi-arthroplasty (HA). Material and Methods: We conducted a retrospective review to assess perioperative blood loss and transfusion rate after intra-articular injection of TXA during HA. This was a single-center, retrospective, single-surgeon, and standard care cohort study covering the period between January and December 2016. One hundred three consecutive patients undergoing HA under spinal or general anesthesia were included. Fifty-four and 49 patients received and did not receive intra-articular injection of TXA during the HA, respectively. After closing the capsule, 50 mL of a TXA solution at a concentration of 1 g/100 mL of saline was injected into joint capsule. We compared the following outcomes: preoperative hemoglobin (HB) level, postoperative day 1 HB level, postoperative day 3 HB level, the net reduction of HB level by postoperative day 3, transfusion rate, and 30- and 90-day postoperative mortality rates. In addition, we use logistic regression to analyze the factors affecting the transfusion rate. Result: Day 3 postoperative HB level and the net reduction in HB level within 3 days following surgery were 93.22 ± 11.70 g/L and 25.98 ± 6.29 g/L in TXA group, respectively, while were 87.10 ± 10.52 g/L and 35.44±8.61 g/L in no-TXA group. Transfusion rate was 9% (5/54) in TXA group and 24% (12/49) in no-TXA group, respectively. The differences were statistically significant between the both groups. Logistic regression indicated that the topical administration of TXA would reduce the risk for transfusion, while in male diabetes mellitus would increase the risk. There were no significant differences in the deep venous thrombosis, pulmonary embolism, and mortality rates of 30 and 90 days postoperatively ( P > .05). Discussion: Because of lower systemic absorption and a higher concentration in the wound, topical use of TXA is safer for elderly patients who may have renal or liver dysfunction. TXA at therapeutic concentration does not affect platelet count, platelet aggregation, or coagulation parameters, and is of value in elderly patients who take antiplatelet drug for secondary prevention of cardiovascular diseases. Conclusion: For patients between 80 and 100 years of age with femoral neck fracture undergoing HA, intra-articular injection of TXA may reduce the perioperative blood loss and transfusion rate without increasing risk of thrombosis.

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