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Age and Ageing Advance Access originally published online on July 28, 2007
Age and Ageing 2007 36(5):538-543; doi:10.1093/ageing/afm079
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Copyright © The Author 2007. Published by Oxford University Press on behalf of the British Geriatrics Society.

Risk factors for insufficient perioperative oral nutrition after hip fracture surgery within a multi-modal rehabilitation programme

Nicolai B. Foss1,2, Pia S. Jensen2 and Henrik Kehlet3

1 Departments of Anaesthesia, Hvidovre University Hospital, Denmark
2 Department of Orthopaedic Surgery, Hvidovre University Hospital, Denmark
3 Section of Surgical pathophysiology, and the Juliane Marie Centre 4074, Rigshospitalet, Denmark

Address correspondence to: Nicolai B. Foss. Email: nbf{at}comxnet.dk

Objective: To examine oral nutritional intake in the perioperative phase in elderly hip fracture patients treated according to a well-defined multi-modal rehabilitation program, including unselected oral nutritional supplementation, and to identify independent risk factors for insufficient nutritional intake.

Design: Prospective, descriptive.

Setting: A specialised hip fracture unit at the department of orthopaedic surgery in a university hospital.

Subjects: Two hundred and sixty-two consecutive, unselected elderly hip fracture patients.

Intervention: Patients were treated according to a well-defined multi-modal care and nutrition plan comprising early surgery, short fasting period, supplementary protein drinks, epidural anaesthesia and analgesia, standardised fluid and transfusion protocols and aggressive mobilisation and physiotherapy. All nutritional intake during the first three post-operative days was recorded, as well as post-operative morbidity and mortality.

Results: Nutritional energy intake during the first three post-operative days was median 90% of BMR and 86% of recommended protein intake. The independent risk factors for an insufficient energy intake were perioperative medical complications, and no association between low nutritional intake in the perioperative phase and the commonly used predictors of low BMI or albumin on admission was found.

Conclusion: Perioperative medical complications and dementia restricted nutritional intake in the perioperative phase. These factors help identify hip fracture patients in whom increased nutritional support is necessary.

Keywords: hip fracture, elderly, nutrition, perioperative, complications

Received 13 November 2006; accepted in revised form 6 March 2007.


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