Inadequate Postoperative Energy Intake Relative to Total Energy Requirements Diminishes Acute Phase Functional Recovery From Hip Fracture

Objective: To investigate whether postoperative voluntary energy intake (El) affects functional recovery with hip fracture during the acute phase. Design: Prospective cohort study. Setting: Three acute care hospitals. Participants: Hip fracture patients (N = 200) who were consecutively admitted to 3 acute hospitals because of falling. Interventions: Not applicable. Main Outcome Measures: Patients were stratified into 3 groups based on the ratio of measured EI to estimated total energy expenditure (TEE) as inadequate (EI/TEE<0.7), intermediate (0.7 <= EI/TEE= 1) groups. The functional status was evaluated using the motor domain of a FIM. We calculated efficiency based on the motor FIM scores (change in postoperative motor FIM scores/length of the rehabilitation period) to assess the beneficial effect of rehabilitation. Results: The median hospital stay was 24 days. The inadequate group comprised 73 (36.5%) patients (median El/TEE, 0.54; interquartile range, 0.42-0.64); intermediate group comprised 92 (46.0%) patients (median EI/TEE, 0.87; interquartile range, 0.78-0.94), and adequate group comprised 35 (17.5%) patients (median EI/TEE, 1.10; interquartile range, 1.04-1.15). Absolute functional gain (AFG) and efficiency of motor FIM gain (EFG) scores were higher in the adequate group than in the others (P<.01). After adjustment for potential confounders, a significant association between postoperative El/TEE group and logarithm of EFG scores was observed to persist (inadequate group, standardized beta = -0.14; reference: adequate group; P=0.03; R-2 for the entire model = 0.25). Conclusions: Postoperative EI that is less than 70% of TEE diminishes functional recovery with hip fracture. (C) 2018 by the American Congress of Rehabilitation Medicine