title: Association Between Preoperative Malnutrition and Postoperative Delirium After Hip Fracture Surgery in Older Adults.
abstract: OBJECTIVE
  To determine whether poor nutritional status can predict postoperative delirium in elderly adults undergoing hip fracture surgery.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Italian orthogeriatric unit.
  
  
  METHODS
  Individuals aged 70 and older (mean age 84.0 ± 6.6, 74.5% female) consecutively admitted for surgical repair of a proximal femur fracture between September 2012 and April 2016 (N = 415).
  
  
  METHODS
  Participants underwent a comprehensive geriatric assessment including nutritional status, which was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). The MNA-SF-based three-class stratification was tested using multivariable logistic regression to assess its role in predicting postoperative delirium (outcome).
  
  
  RESULTS
  Seventy-eight malnourished individuals (MNA-SF score 0-7), 185 at risk of malnutrition (MNA-SF score 8-11), and 152 who were well nourished (MNA-SF score 12-14) were compared. On average, individuals with poor nutritional status were more disabled and more cognitively impaired than those who were well nourished and those at risk of malnutrition. Moreover, those who were malnourished were more likely to have postoperative delirium. Multivariate regression analysis adjusted for age, sex, comorbidity, functional impairment, preoperative cognitive status, and American Society of Anesthesiologists score showed that those who were at risk of malnutrition (odds ratio (OR) = 2.42, 95% confidence interval (CI) = 1.29-4.53) and those who were overtly malnourished (OR = 2.98, 95% CI = 1.43-6.19) were more likely to develop postoperative delirium.
  
  
  CONCLUSIONS
  This is the first study in a Western population showing that risk of malnutrition and overt malnutrition, as assessed using the MNA-SF, are independent predictors of postoperative delirium. Accordingly, nutritional status should be assessed in individuals with hip fracture before surgery to determine risk of developing delirium.
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.|NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, Monza, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mazzola
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Libby
authors.initials: L
authors.lastname: Ward
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Zazzetta
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Broggini
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Anzuini
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Breanna
authors.initials: B
authors.lastname: Valcarcel
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Brathwaite
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.|Geriatric Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York.
authors.forename: Giulio M
authors.initials: GM
authors.lastname: Pasinetti
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.|NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, Monza, Italy.|Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellelli
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.|NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, Monza, Italy.|Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Annoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007558:Italy; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D015596:Nutrition Assessment; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors
keywords: Mini-Nutritional Assessment Short Form; elderly; hip fracture; malnutrition; postoperative delirium