The effects of nutritional status on outcome after hip fracture

Objective: To determine the effect of nutrition on patient outcome after hi p fracture. Study Design: Retrospective review of prospectively collected data. Methods: Four hundred ninety hip fracture patients had albumin and total ly mphocyte count levels determined at the time of admission and constituted t he study population. These variables were examined as predictors for outcom es, including: in-hospital mortality, postoperative complications, hospital length of stay, hospital discharge status, one-year mortality rate, ambula tory ability, and independence in basic and instrumental activities of dail y living twelve months after surgery. Results: Eighty-seven patients (18 percent) were found to be malnourished o n hospital admission based on a preoperative albumin level of < 3.5 grams/d eciliter, and 280 patients (57 percent) based on a total lymphocyte count o f < 1,500 cells/milliliter. An albumin level of < 3.5 grams/deciliter was p redictive for increased length of stay (p = 0.03) and for in-hospital morta lity (p = 0.03). A total lymphocyte count < 1,500 cells/milliliter was pred ictive for one-year mortality (p < 0.01). Patients with abnormal albumin an d total lymphocyte count were 2.9 times more likely to have a length of sta y greater than two weeks (p = 0.03), 3.9 times more likely to die within on e year after surgery (p = 0.02), and 4.6 times less likely to recover their prefracture level of independence in basic activities Of dairy living (p < 0.01). Neither parameter was predictive for patients developing a postoper ative complication, hospital discharge status (home versus nursing home), r ecovery of prefracture ambulatory ability, or independence in instrumental activities of daily living at twelvemonth follow-up. Conclusion: Patients at risk for poor outcomes after hip fracture can be id entified using relatively inexpensive laboratory tests such as albumin and total lymphocyte count.