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, 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.