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Impact of malnutrition on 12‐month mortality following acute hip fracture
Author(s) -
Bell Jack J.,
Pulle Ranjeev C.,
Crouch Alisa M.,
Kuys Suzanne S.,
Ferrier Rebecca L.,
Whitehouse Sarah L.
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13429
Subject(s) - medicine , hip fracture , malnutrition , intensive care medicine , osteoporosis
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 ( N ovember 2010– O ctober 2011). The 12‐month mortality data were obtained by a dual search of the mortality registry and Q ueensland H ealth database. Malnutrition was evaluated using the S ubjective G lobal A ssessment. 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 C harlson C omorbidity I ndex 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), C harlson C omorbidity I ndex ( 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.