The Effects of Different Nutritional Measurements on Delayed Wound Healing After Hip Fracture in the Elderly
Introduction
In the population older than 60 y, fracturing of a hip is one of the commonest reasons for being admitted to a hospital. Age-related changes increase the risk of perioperative complications. Many authors have demonstrated that there is a significant incidence of malnutrition in the elderly, and poorer outcomes after surgical procedures in patients with hip fractures 1, 2, 3, 4, 5, 6. The relationship between retarded wound healing and malnourishment is well documented and confirmed by clinical and experimental studies 1, 2, 7, 8. The delayed wound healing is devastating for the elder patients undergoing internal fixation of hip fracture.
However, the identification and classification of nutritional status in the elderly is a difficult phenomenon to study as no gold standard methodologies exist, although several different approaches have been used [9]. Various preoperative parameters and nutritional equations have been used to predict postoperative wound-healing status 1, 2, 3, 6, 7, 9, 10, 11, 12, 14. The hematological parameters most commonly used to assess the nutritional status are the serum albumin level and the total lymphocyte count. These are practical and reproducible tests that are available in most surgical patients. A negative Rainey MacDonald nutritional index (RMNI) was reported to be significantly associated with longer hospitalization and higher rates of complications [12]. The efficacy and validity of these parameters or equation have not been established. Mini-nutritional assessment (MNA) is a useful diagnostic tool for the identification of elderly patients at risk from malnutrition and those who are already malnourished in this hospital setting [9].
Nutritional evaluation and the impact of malnutrition in the orthopedic surgical patients have not received serious attention, especially in some developing countries. We undertook a prospective study to better define the role of preoperative nutritional status on postoperative wound healing in the elder patients undergoing joint surgery. The study determined the correlation between different nutritional parameters and wound healing status, the use and the validity of RMNI, and MNA in elderly hip fracture patients.
Section snippets
Patients Selection
Two hundred seven hip fracture patients older than 60 y treated surgically between September 2002 and December 2007 at the Medical Center of Soochow University were included in the study. All these fractures were isolated trauma to the hip. All patients were identified at the time of hospital admission and entered into the prospective database. The study was approved by the local Research Ethics Committees and all subjects gave written consent to participate. Patients with pathological
Results
There were 81 males and 126 females with an average age of 75.93 ± 6.89 y (62–91 y); 131 cases with femoral neck fractures, 76 cases with intertrochanteric fractures. Patients with cervical fractures were treated with arthroplasty. Patients with trochanteric fractures were treated with plates and sliding screws.
There were 46 (22.2%) cases of delayed wound healing; 13 (28.3%) of these cases had superficial wound infections. They were successfully treated with intravenous antibiotics. There were no
Discussion
Malnutrition is a serious problem and malnourished patients could have prolonged hospital stays complicated by increased incidence of infection, wasting of skeletal muscle mass, and generalized weakness. Furthermore, a malnourished state in an orthopaedic patient is likely to be exacerbated because fractures are associated with increased rates of catabolism 1, 2, 3, 4, 5, 6, 7, 13. Klein et al. [13] undertook a study to better understand the impact of perioperative nutritional status on
References (19)
- et al.
Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications
J Arthroplasty
(1991) - et al.
Aging: A barrier to renutrition? Nutritional and immunologic evidence in rats
Am J Clin Nutr
(2000) - et al.
Prognostic nutritional index in gastrointestinal surgery
Am J Surg
(1980) - et al.
The mini-nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients
Nutrition
(1999) - et al.
A methodological framework for assessing health indices
J Chronic Dis
(1985) - et al.
A prospective assessment of nutritional status and complications in patients with fractures of the hip
J Orthop Trauma
(1990) - et al.
The effects of nutritional status on outcome after hip fracture
J Orthop Trauma
(1999) - et al.
Delayed wound healing and nutritional deficiencies after total hip arthroplasty
Clin Orthop
(1993) - et al.
Nutritional assessment of orthopedic patients
Mayo Clinic Proc
(1981)
Cited by (92)
Comparison study of patient demographics and risk factors for infections following primary total elbow arthroplasty
2022, Seminars in Arthroplasty JSESAnesthesia for the elderly: Effects of aging on perioperative and postoperative care
2022, Beauty, Aging and AntiAgingPerioperative Laboratory Markers as Risk Factors for Surgical Site Infection After Elective Hand Surgery
2021, Journal of Hand SurgeryNutrition in Surgery: An Orthopaedic Perspective
2023, Journal of Bone and Joint SurgeryCompound Effect of Hypoalbuminemia and Obesity on Complications after Autologous Breast Reconstruction
2023, Plastic and Reconstructive Surgery