Systematic review of nutrition status in elderly patients with hip fracture and its effect on prognosis of the surgery

Objective To understand the nutrition status in elderly patients with hip fracture, and clarify its effects on postoperative functional recovery, complications and mortality based on literature analysis of the past 10 years. Methods PubMed, Medline, Embase Database, Wanfang Database, Chinese National Knowledge Infrastructure (CNKI) and China Biology Medicine disc (CBMdisc) were searched, and relevant researches published from 1st January, 2010 to 31th May, 2019 were collected. Single rate Meta-analysis was used to integrate the prevalence and mortality of malnutrition. A qualitative systematic review was used to analyze the relationship between nutritional status and prognosis after surgery. Results A total of 11 articles was included, including 21 791 patients. Meta-analysis showed that the mean prevalence of malnutrition during hospitalization in elderly patients with hip fracture was 46% (95%CI: 45%-47%) using serum albumin (ALB) , and was 17% (95%CI: 12%-22%) assessing by the Mini Nutritional Assessment (MNA) , and the risk of malnutrition prevalence was 42% (95%CI: 45%-47%) . The results of qualitative evaluation showed that compared with the well-nutrition group (Short-form MNA 12-14 points) , the malnutrition risk group (Short-form MNA 8-11 points) had lower activity ability 4 months after the operation (OR=2.03, 95%CI: 1.24-3.31) , and the MNA score decreased by 1 point, the risk of death increased by 15% (HR=0.869, 95%CI: 0.757-0.998) . The malnutrition group (ALB<3.5 g/dl) had a higher incidence of sepsis (P<0.001) and pulmonary infection (P=0.019) , with every 1 g/dl reduction in ALB and 0.59-fold increased risk of death (RR=0.59, 95%CI: 0.53-0.65) . Conclusions The incidence of hip fracture malnutrition or malnutrition risk is very high in the elderly patients with hip fracture. Both malnutrition and malnutrition risk have negative effects on postoperative functional recovery, complications and death rates, and the worse the nutritional status, the worse the prognosis. So, both ALB and MNA are recommended to be included in the care plan of elderly patients with hip fracture. When ALB is failed to diagnose malnutrition, the MNA evaluation method should be adopted to find the problems of nutrition and offer nutritional intervention in advance. Key words: Aged; Hip fractures; Nutritional status; Malnutrition; Nutritional assessment; Prognosis