Impact of malnutrition on 12-month mortality following acute hip fracture
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 relev...
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Published in | ANZ journal of surgery Vol. 86; no. 3; pp. 157 - 161 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Melbourne
Wiley Publishing Asia Pty Ltd
01.03.2016
Blackwell Publishing Ltd |
Subjects | |
Online Access | Get full text |
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Abstract | 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 (November 2010–October 2011). The 12‐month mortality data were obtained by a dual search of the mortality registry and Queensland Health database. Malnutrition was evaluated using the Subjective Global Assessment. 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 Charlson Comorbidity Index 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), Charlson Comorbidity Index (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. |
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AbstractList | 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.
An ethics approved, prospective, consecutive audit was undertaken for all surgically treated hip fracture inpatients admitted to a dedicated orthogeriatric unit (November 2010-October 2011). The 12-month mortality data were obtained by a dual search of the mortality registry and Queensland Health database. Malnutrition was evaluated using the Subjective Global Assessment. 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 Charlson Comorbidity Index was retrospectively applied. All diagnoses were confirmed by the treating orthogeriatrician.
A total of 322 of 346 patients were available for audit. Increased age (P = 0.004), admission from residential care (P < 0.001), Charlson Comorbidity Index (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.
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. 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 (November 2010–October 2011). The 12‐month mortality data were obtained by a dual search of the mortality registry and Queensland Health database. Malnutrition was evaluated using the Subjective Global Assessment. 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 Charlson Comorbidity Index 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), Charlson Comorbidity Index (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. BACKGROUNDStudies 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.METHODSAn ethics approved, prospective, consecutive audit was undertaken for all surgically treated hip fracture inpatients admitted to a dedicated orthogeriatric unit (November 2010-October 2011). The 12-month mortality data were obtained by a dual search of the mortality registry and Queensland Health database. Malnutrition was evaluated using the Subjective Global Assessment. 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 Charlson Comorbidity Index was retrospectively applied. All diagnoses were confirmed by the treating orthogeriatrician.RESULTSA total of 322 of 346 patients were available for audit. Increased age (P = 0.004), admission from residential care (P < 0.001), Charlson Comorbidity Index (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.CONCLUSIONSFindings 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. 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 (November 2010-October 2011). The 12-month mortality data were obtained by a dual search of the mortality registry and Queensland Health database. Malnutrition was evaluated using the Subjective Global Assessment. 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 Charlson Comorbidity Index 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), Charlson Comorbidity Index (P = 0.007), malnutrition (P < 0.001), time to mobilize >48h (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. |
Author | Crouch, Alisa M. Kuys, Suzanne S. Ferrier, Rebecca L. Bell, Jack J. Whitehouse, Sarah L. Pulle, Ranjeev C. |
Author_xml | – sequence: 1 givenname: Jack J. surname: Bell fullname: Bell, Jack J. email: Jack_Bell@health.qld.gov.au organization: Metro North Hospital and Health Service, The Prince Charles Hospital, Queensland, Brisbane, Australia – sequence: 2 givenname: Ranjeev C. surname: Pulle fullname: Pulle, Ranjeev C. organization: Metro North Hospital and Health Service, The Prince Charles Hospital, Queensland, Brisbane, Australia – sequence: 3 givenname: Alisa M. surname: Crouch fullname: Crouch, Alisa M. organization: Metro North Hospital and Health Service, The Prince Charles Hospital, Queensland, Brisbane, Australia – sequence: 4 givenname: Suzanne S. surname: Kuys fullname: Kuys, Suzanne S. organization: School of Physiotherapy, Australian Catholic University, Queensland, Brisbane, Australia – sequence: 5 givenname: Rebecca L. surname: Ferrier fullname: Ferrier, Rebecca L. organization: Metro North Hospital and Health Service, The Prince Charles Hospital, Queensland, Brisbane, Australia – sequence: 6 givenname: Sarah L. surname: Whitehouse fullname: Whitehouse, Sarah L. organization: Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Queensland, Australia |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26748473$$D View this record in MEDLINE/PubMed |
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Dis. contributor: fullname: Paksima N – ident: e_1_2_6_3_1 doi: 10.1046/j.1532-5415.2002.50455.x – ident: e_1_2_6_18_1 doi: 10.1016/0021-9681(87)90171-8 – ident: e_1_2_6_9_1 doi: 10.2106/JBJS.J.01077 – ident: e_1_2_6_33_1 doi: 10.1001/jama.2014.6499 – ident: e_1_2_6_16_1 doi: 10.1111/j.1741-6612.2012.00638.x – ident: e_1_2_6_14_1 doi: 10.1007/s00774-005-0654-z – ident: e_1_2_6_32_1 doi: 10.1111/j.1532-5415.2009.02377.x – volume: 10 start-page: 435 year: 1994 ident: e_1_2_6_30_1 article-title: The skeleton in the hospital closet. 1974 publication-title: Nutrition contributor: fullname: Butterworth CE – ident: e_1_2_6_10_1 doi: 10.1007/s001980050285 – ident: e_1_2_6_23_1 doi: 10.1111/jgs.12648 – volume-title: Australian and New Zealand Guideline for Hip Fracture Care: Improving Outcomes in Hip Fracture Management of Adults. 2014 ident: e_1_2_6_5_1 contributor: fullname: Australian and New Zealand Hip Fracture Registry (ANZHFR) Steering Group – ident: e_1_2_6_17_1 doi: 10.2105/AJPH.84.11.1807 – ident: e_1_2_6_2_1 doi: 10.1046/j.1532-5415.2003.51110.x – ident: e_1_2_6_8_1 doi: 10.1016/j.injury.2011.05.017 – ident: e_1_2_6_31_1 doi: 10.1016/j.clnu.2013.12.003 |
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Studies investigating the relationship between malnutrition and post‐discharge mortality following acute hip fracture yield conflicting results.... Studies investigating the relationship between malnutrition and post-discharge mortality following acute hip fracture yield conflicting results. This study... Background Studies investigating the relationship between malnutrition and post-discharge mortality following acute hip fracture yield conflicting results.... BACKGROUNDStudies investigating the relationship between malnutrition and post-discharge mortality following acute hip fracture yield conflicting results. This... |
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SubjectTerms | Aged Aged, 80 and over Cause of Death Comorbidity Confidence intervals Delirium Embolisms Female Fractures Health risk assessment hip fractures Hip Fractures - mortality Hip joint Hospitalization Humans Male Malnutrition Malnutrition - mortality Middle Aged Mortality Postoperative Complications pulmonary embolism Queensland - epidemiology Retrospective Studies Risk Factors Surgery |
Title | Impact of malnutrition on 12-month mortality following acute hip fracture |
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