Risk factors for insufficient perioperative oral nutrition after hip fracture surgery within a multi-modal rehabilitation programme

Objective To examine oral nutritional intake in the perioperative phase in elderly hip fracture patients treated according to a well-defined multi-modal rehabilitation program, including unselected oral nutritional supplementation, and to identify independent risk factors for insufficient nutritional intake. Design Prospective, descriptive. Setting A specialised hip fracture unit at the department of orthopaedic surgery in a university hospital. Subjects Two hundred and sixty-two consecutive, unselected elderly hip fracture patients. Intervention Patients were treated according to a well-defined multi-modal care and nutrition plan comprising early surgery, short fasting period, supplementary protein drinks, epidural anaesthesia and analgesia, standardised fluid and transfusion protocols and aggressive mobilisation and physiotherapy. All nutritional intake during the first three post-operative days was recorded, as well as post-operative morbidity and mortality. Results Nutritional energy intake during the first three post-operative days was median 90% of BMR and 86% of recommended protein intake. The independent risk factors for an insufficient energy intake were perioperative medical complications, and no association between low nutritional intake in the perioperative phase and the commonly used predictors of low BMI or albumin on admission was found. Conclusion Perioperative medical complications and dementia restricted nutritional intake in the perioperative phase. These factors help identify hip fracture patients in whom increased nutritional support is necessary.