title: Impact of malnutrition on 12-month mortality following acute hip fracture.
abstract: BACKGROUND
  Studies investigating the relationship between malnutrition and post-discharge mortality following acute hip fracture yield conflicting results. This study aimed to determine whether malnutrition independently predicted 12-month post-fracture mortality after adjusting for clinically relevant covariates.
  
  
  METHODS
  An ethics approved, prospective, consecutive audit was undertaken for all surgically treated hip fracture inpatients admitted to a dedicated orthogeriatric unit (November 2010-October 2011). The 12-month mortality data were obtained by a dual search of the mortality registry and Queensland Health database. Malnutrition was evaluated using the Subjective Global Assessment. Demographic (age, gender, admission residence) and clinical covariates included fracture type, time to surgery, anaesthesia type, type of surgery, post-surgery time to mobilize and post-operative complications (delirium, pulmonary and deep vein thrombosis, cardiac complications, infections). The Charlson Comorbidity Index was retrospectively applied. All diagnoses were confirmed by the treating orthogeriatrician.
  
  
  RESULTS
  A total of 322 of 346 patients were available for audit. Increased age (P = 0.004), admission from residential care (P < 0.001), Charlson Comorbidity Index (P = 0.007), malnutrition (P < 0.001), time to mobilize >48 h (P < 0.001), delirium (P = 0.003), pulmonary embolism (P = 0.029) and cardiovascular complication (P = 0.04) were associated with 12-month mortality. Logistic regression analysis demonstrated that malnutrition (odds ratio (OR) 2.4 (95% confidence interval (CI) 1.3-4.7, P = 0.007)), in addition to admission from residential care (OR 2.6 (95% CI 1.3-5.3, P = 0.005)) and pulmonary embolism (OR 11.0 (95% CI 1.5-78.7, P = 0.017)), independently predicted 12-month mortality.
  
  
  CONCLUSIONS
  Findings substantiate malnutrition as an independent predictor of 12-month mortality in a representative sample of hip fracture inpatients. Effective strategies to identify and treat malnutrition in hip fracture should be prioritized.
authors.affiliation: Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Bell
authors.affiliation: Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Ranjeev C
authors.initials: RC
authors.lastname: Pulle
authors.affiliation: Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Crouch
authors.affiliation: School of Physiotherapy, Australian Catholic University, Brisbane, Queensland, Australia.
authors.forename: Suzanne S
authors.initials: SS
authors.lastname: Kuys
authors.affiliation: Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Ferrier
authors.affiliation: Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.|Orthopaedic Research Unit, Institute of Health and Biomedical Innovation, Queensland University of Technology, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Whitehouse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006620:Hip Fractures / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000401:mortality*; D008875:Middle Aged; D011183:Postoperative Complications; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: aged; hip fractures; malnutrition; mortality; pulmonary embolism