The effects of nutritional status on outcome after hip fracture.
OBJECTIVE
To determine the effect of nutrition on patient outcome after hip fracture.


METHODS
Retrospective review of prospectively collected data.


METHODS
Four hundred ninety hip fracture patients had albumin and total lymphocyte count levels determined at the time of admission and constituted the study population. These variables were examined as predictors for outcomes, including: in-hospital mortality, postoperative complications, hospital length of stay, hospital discharge status, one-year mortality rate, ambulatory ability, and independence in basic and instrumental activities of daily living twelve months after surgery.


RESULTS
Eighty-seven patients (18 percent) were found to be malnourished on hospital admission based on a preoperative albumin level of < 3.5 grams/deciliter, and 280 patients (57 percent) based on a total lymphocyte count of < 1,500 cells/milliliter. An albumin level of < 3.5 grams/deciliter was predictive for increased length of stay (p = 0.03) and for in-hospital mortality (p = 0.03). A total lymphocyte count < 1,500 cells/milliliter was predictive for one-year mortality (p < 0.01). Patients with abnormal albumin and total lymphocyte count were 2.9 times more likely to have a length of stay greater than two weeks (p = 0.03), 3.9 times more likely to die within one year after surgery (p = 0.02), and 4.6 times less likely to recover their prefracture level of independence in basic activities of daily living (p < 0.01). Neither parameter was predictive for patients developing a postoperative complication, hospital discharge status (home versus nursing home), recovery of prefracture ambulatory ability, or independence in instrumental activities of daily living at twelve-month follow-up.


CONCLUSIONS
Patients at risk for poor outcomes after hip fracture can be identified using relatively inexpensive laboratory tests such as albumin and total lymphocyte count.
Koval
K J
KJ
Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, New York 10003, USA.
Maurer
S G
SG
Su
E T
ET
Aharonoff
G B
GB
Zuckerman
J D
JD
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing / Q000502:physiology*; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome