title: Malnutrition - An underestimated factor in the inpatient treatment of traumatology and orthopedic patients: A prospective evaluation of 1055 patients.
abstract: BACKGROUND
  Suboptimal nutritional status is often observed among hospitalized patients across all medical specialties. The objective of the present study was to (1) analyze the prevalence of malnutrition in hospitalized orthopedic and trauma patients and (2) to evaluate the relationship between malnutrition and selected clinical outcomes.
  
  
  METHODS
  The prospective field study was conducted between 06/2014 and 06/2015 in a German level I trauma center (Department of Traumatology, Septic Trauma Surgery and Arthroplasty) with a total number of 1055 patients. At hospital admission, patients were checked for malnutrition using the validated Nutritional Risk Screening (NRS). Patients at risk for malnutrition were defined as NRS≥3. Quality of life (SF-36) was assessed to evaluate the physical and mental health status prior to hospitalization. Clinical outcomes under consideration included 1) rate of adverse events, 2) length of hospitalization, and 3) mobilization after operative and conservative treatment. Patients were included independently of surgical intervention or age.
  
  
  RESULTS
  22.3% (235) of our patients were at risk for malnutrition (NRS≥3) while a regular nutritional status (NRS<3) was diagnosed in 77.7% (819). The highest prevalence of malnutrition was found in Septic Surgery with 31.0% (106), followed by Traumatology with 19.2% (100) and Arthroplasty with 15.1% (29). Higher prevalence of malnutrition was observed among patients with typical fractures of the elderly, such as lumbar spine and pelvis (47.4%), proximal femur (36.4%) and proximal humeral (26.7%) fractures. Furthermore, patients at risk for malnutrition showed prolonged hospitalization (13.7±11.1 vs. 18.2±11.7days), delayed postoperative mobilization (2.2±2.9 vs. 4.0±4.9days) and delayed mobilization after conservative treatment (1.1±2.7 vs. 1.8±1.9days). A statistically significant correlation of NRS with each parameter (Spearman's rank correlation, p<0.05) was observed. The incidence of adverse events in patients at risk for malnutrition was statistically significantly higher compared to that of patients with a regular nutritional status (37.2% vs. 21.1%, p<0.001).
  
  
  CONCLUSIONS
  Malnutrition is widespread regarding hospitalized patients in the field of orthopedic and trauma surgery and results in suboptimal clinical outcome. It should be considered as an important factor that significantly contributes to delayed recovery. Especially elderly trauma patients and patients suffering from postoperative infections should be monitored carefully during hospitalization.
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: christoph.ihle@googlemail.com.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ihle
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: t.freude@salk.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Freude
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: cbahrs@bgu-tuebingen.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Bahrs
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: eva.zehendner@gmx.de.
authors.forename: Eva
authors.initials: E
authors.lastname: Zehendner
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: braunsbergja@googlemail.com.
authors.forename: Janick
authors.initials: J
authors.lastname: Braunsberger
authors.affiliation: Institute of Biological Chemistry and Nutritional Science, University of Hohenheim, Garbenstr. 30, 70593 Stuttgart, Germany. Electronic address: biesal@uni-hohenheim.de.
authors.forename: Hans Konrad
authors.initials: HK
authors.lastname: Biesalski
authors.affiliation: Institute of Biological Chemistry and Nutritional Science, University of Hohenheim, Garbenstr. 30, 70593 Stuttgart, Germany. Electronic address: christine.lambert@uni-hohenheim.de.
authors.forename: Christine
authors.initials: C
authors.lastname: Lambert
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: ustoeckle@bgu-tuebingen.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stöckle
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: ewintermeyer@bgu-tuebingen.de.
authors.forename: Elke
authors.initials: E
authors.lastname: Wintermeyer
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: julia@familie-gruenwald.eu.
authors.forename: Julia
authors.initials: J
authors.lastname: Grünwald
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: leonard@familie-gruenwald.eu.
authors.forename: Leonard
authors.initials: L
authors.lastname: Grünwald
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: gochs@bgu-tuebingen.de.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ochs
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: iflesch@bgu-tuebingen.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Flesch
authors.affiliation: Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany. Electronic address: andreas.nuessler@gmail.com.
authors.forename: Andreas
authors.initials: A
authors.lastname: Nüssler
mesh_terms: D000368:Aged; D001066:Appetite / Q000502:physiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007297:Inpatients / Q000523:psychology; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D009985:Orthopedics; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D014194:Traumatology; D015431:Weight Loss
keywords: Malnutrition; NRS 2002; Nutritional Risk Screening; Quality of life; SF-36; Traumatology