Influence of Preoperative Nutritional Status on Surgical Outcomes of Arthroplasty in Geriatric Femoral Neck Fractures

BACKGROUND: Patients with geriatric neck of femur (NOF) fractures often have multiple medical conditions and compromised baseline nutrition, impacting arthroplasty outcomes. Indicators like BMI, albumin, hemoglobin, urea, creatinine, CRP, and HbA1c influence nutritional status and postoperative results. This study evaluates the impact of preoperative nutrition on surgical outcomes, including postoperative complications, mobility, and pain scores in geriatric femoral neck fractures.

METHODS: A retrospective study of 141 geriatric patients with NOF fractures admitted to Kuala Lumpur General Hospital between 2022-2023, treated operatively, was conducted. Associations of age, gender, ethnicity, BMI, education, smoking status, comorbidity, pre-fracture mobility, American Society of Anesthesiologists (ASA) level, and perioperative nutritional parameters with post-surgical complications, mobility, and WOMAC scores 1-year post-surgery were analyzed using logistic regression.

RESULTS: Higher BMI (AOR = 1.21, 95% CI: 1.07-1.42, P = 0.03) and ASA levels ≥2 (AOR = 2.53, 95% CI: 1.30-4.91, P = 0.01) were significant predictors of post-surgical complications. Abnormal hematological variables, including hemoglobin (AOR = 1.78, 95% CI: 1.45-2.45, P < 0.001), urea (AOR = 1.35, 95% CI: 1.15-1.60, P = 0.002), creatinine (AOR = 1.20, 95% CI: 1.00-1.52, P = 0.04), and HbA1c (AOR = 1.40, 95% CI: 1.25-1.67, P = 0.004), were also associated with complications. BMI (AOR = 1.12, 95% CI: 1.06-1.30, P = 0.049) and abnormal hematological variables, including hemoglobin (AOR = 1.99, 95% CI: 1.05-2.70, P = 0.003), urea (AOR = 1.58, 95% CI: 1.06-1.95, P = 0.006), creatinine (AOR = 1.21, 95% CI: 1.09-1.38, P = 0.048), and HbA1c (AOR = 1.98, 95% CI: 1.25-2.57, P = 0.002), were significant predictors of reduced post-surgical mobility. No significant factors were associated with WOMAC scores at 1 year.

CONCLUSION: Preoperative nutritional status significantly impacts outcomes in geriatric patients undergoing arthroplasty for femoral neck fractures. Comprehensive preoperative nutritional assessments are essential for improving postoperative outcomes.