Do We Care About Nutritional Support in Patients Hospitalized with a Diagnosis of Femoral Neck Fracture?

Year 2022, Volume: 17 Issue: 3, 55 - 62, 02.11.2022

Emel Yıldız Halil Yıldız Özlem Arık Filiz.ozyigit Özyiğit

https://doi.org/10.17517/ksutfd.951993

Abstract

Abstract

Objective: Femoral neck fractures (FNF) occur in the intracapsular region of the proximal femur. The incidence of fractures in the proximal femur increases with age. FNF’s cause high mortality and morbidity. Malnutrition is also one of the problems of these patients. In this study, it was aimed to reveal the importance of necessary nutritional follow-up in patients hospitalized in our hospital.

Material and Methods: Data of patients hospitalized in Kutahya Health Sciences University Evliya Celebi Training and Research Hospital with a diagnosis of FNF between 2017-2018 were retrospectively scanned from the patient file and the hospital automation system. Two hundred and twenty nine patients were included in the study. Hospitalization diagnosis, age and gender, albumin, C-reactive protein (CRP), and lymphocyte values of the patients were measured.

The nutritional risk score (NRS-2002) made for each patient in the automation system of our hospital was checked. For nutritional support, it was checked whether a consultation was requested from the nutrition support team (NST).

Results: The mean age of the patients included in the study was found to be 74 years. 79.3% were over 65 years old, while 20.97% were under 65. It was determined that 65.1% of the patients had albumin, 24.5% lymphocyte and 88.2% CRP values outside the normal range. There was a statistically significant negative correlation of 41% between the patients albumin and age variable (p<0.05). When looking at NRS-2002, 94.8% was seen as not calculated. NST consultation was not requested from any of the patients.

Conclusion: Considering the perioperative nutritional support of hip fracture patients can reduce morbidity and mortality and improve quality of life. In our study, we revealed the necessity of giving more importance to nutritional support.

Keywords

femur neck fracture, nutritional risk score, nutritional support team

Femur Boyun Kırığı Tanısı ile Yatan Hastalarda Beslenme Desteğini Önemsiyor muyuz?

Abstract

Özet

Amaç: Femur boyun kırıkları (FBK), proksimal femurun intrakapsüler bölgesinde oluşan kırıklardır. Femur proksimalindeki kırıkların insidansı yaşla doğru orantılı olarak artış gösterir. FBK yüksek mortalite ve morbiditeye neden olan kırıklardır. Yetersiz beslenme de bu hastaların sorunlarından biridir. Bu çalışmada FBK nedeni ile hastanemize yatışı yapılan hastalarda gerekli beslenme takibinin öneminin ortaya konulması amaçlandı.

Gereç ve Yöntemler: Kütahya Sağlık Bilimleri Üniversitesi Evliya Çelebi Eğitim ve Araştırma Hastanesi’ne 2017-2018 yılları arasında FBK tanısı ile yatan hastalara ait veriler retrospektif olarak hasta dosyası ve hastane otomasyon sisteminden tarandı. Çalışmaya 229 hasta dâhil edildi. Hastaların yatış tanıları, yaş

ve cinsiyeti, albümin, C-reaktif protein (CRP), lenfosit tahlilleri değerlendirildi. Hastanemiz otomasyon sisteminde her yatan hasta için yapılan nutrisyon risk skorlamasına (NRS-2002) bakıldı. Nutrisyon desteği için, beslenme destek ekibinden (BDE) konsültasyon istenip-istenmediğine bakıldı.

Bulgular: Çalışmaya dâhil edilen hastaların ortalama yaşları 74 olarak bulundu. Hastaların %79.3’ü 65 yaş üstündeyken, %20.97’si 65 yaş altıydı. Hastaların %65.1`inin albümin, %24.5`inin lenfosit, %88.2`sinin ise CRP değeri normal aralıklar dışında olduğu tespit edildi. Hastaların albümin ve yaş değişkeni arasında negatif yönde, istatistiksel açıdan %41`lik anlamlı bir ilişki vardı (p<0.05). NRS-2002`ye bakıldığında ise %94.8`i hesaplanmamış olarak görüldü. Hastaların hiçbirinden BDE›den konsültasyon istenmediği görüldü.

Sonuç: Kalça kırığı hastalarının perioperatif beslenme desteğinin göz önünde bulundurulması hastalarda morbidite ve mortaliteyi azaltıp, yaşam kalitesini iyileştirebilir. Biz, çalışmamızda beslenme desteğine daha çok önem verilmesinin gerekliliğini ortaya koyduk.

Keywords

femur boyun kırığı, nutrisyonel risk skorlaması, beslenme destek ekibi

References

• Öztürk İ, Toker S, Ertürer E, Aksoy B, Seçkin F. Kalça kırığı nedeniyle ameliyat edilen 65 yaş üstü hastalarda mortaliteye etki eden risk faktörlerinin değerlendirilmesi. Acta Orthop Traumatol Turc 2008;42:16-21.
• Morey V.M, Song Y.D, Whang J.S, Kang Y.G, Kim T.K. Can serum albümin level and total lymphocyte count be surrogates for malnutrition to predict wound complications after total knee arthroplasty? J Arthroplast 2016;31:1317–1321.
• Utku T. Enteral ve parenteral nutrisyonun takibi. Klinik Gelişim 2011;24:26-33.
• Kanis J, Oden A, Mc Closkey E, Johansson H, Wahl D, Cooper C. A systemic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012;23:2239-2256.
• Nieves J.W, Formica C, Ruffing J, Zion M, Garrett P, Lindsay R et al. Males have larger skeletal size and bone mass than females, despite comparable body size. J Bone Miner Res 2005;20:529-535.
• Hedlund R, and Lindgren U. Trauma type, age, and gender as determinants of hip fracture. J Orthop Res 1987;5:242-246.
• Johnell O, J. Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis Int 2006;17:1726-1733.
• Johansen A, Maizura Mansor M, Beck S, Mahoney H, Thomas S. Outcome following hip fracture: post-discharge residence and long-term mortality. Age Ageing 2010;39:653-656.
• O'Leary L, Jayatilaka L, Leader R, Fountain J. Poor nutritional status correlates with mortality and worse postoperative outcomes in patients with femoral neck fractures. Bone Joint J 2021;103:164-169.
• Barsoum WK, Helfand R, Krebs V, Christopher W. Managing perioperative risk in the hip fracture patient. Cleve Clin J Med 2006;73:46-50.
• Bohl DD, Shen MR, Hannon CP, Fillingham YA, Darrith B, Della Valle CJ. Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture. J Bone Joint Surg Am 2017;99:2110–2118.
• Helminen H, Luukkaala T, Saarnio J, Nuotio M. Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes. Injury 2017;48:903-908.
• Yıldız E, Ekici MF, Alkan S, Yıldız Hİ, Arık Ö, Balcı C. Geriatrik hasta grubunun yoğun bakımdan çıkışı ve mortalitesinin retrospektif olarak değerlendirilmesi. JAMER 2021;6:16-24.
• Moises Auron-Gomez, Franklin Michota. Medical management of hip fracture. Geriatric Medicine Clinics 2008;24:701-719.
• Lichtblau S. Treatment of hip fractures in the elderly-the decision process. Mt Sinai J Med 2002;69:250-260.
• Garcia Lazaro M. Montero Perez-Barquero M, Carpintero Benitez P. The role of malnutrition and other medical factors in the evolution of patients with hip fracture. An Med Interna 2004;21:557-563.
• Remelli F, Vitali A, Zurlo A, Volpato S. Vitamin D deficiency and sarcopenia in older persons. Nutrients 2019;11:2861.
• Malafarina V, Reginster J.Y, Cabrerizo S. Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients 2018;10:555.
• Shin Lee J, Kang JE, Park SH Jin HK, Jang SM, Kim SA et al. Nutrition and clinical outcomes of nutrition support in multidisciplinary team for critically ill patients. Nutr Clin Pract 2018;33:633-639.
• Kondrup J, Allison S.P, Elia M, Vellas B, Plauth M. ESPEN Guidelines for nutrition ccreening 2002. Clinical Nutrition 2003;22:415–421.
• Wyers CE, Reijven PLM, Breedveld-Peters JL, DenissenK. FM, Schotanus MGM, van Dongen MC J et al. Efficacy of nutritional intervention in elderly after hip fracture: A multicenter randomized controlled trial. The Journals of Gerontology 2018;73:1429-1437.
• Bustamante MD, Alarcon T, Menendez-Colino R, Ramirez-Martin R, Otero A, Gonzalez-Montalvo JI. Prevalence of malnutrition in a cohort of 509 patients with acute hip fracture: the importance of a comprehensive assessment. European Journal of Clinical Nutrition 2018;72:77-81.
• Yaoquan He, Jun Xiao, Zhanjun Shi, Jinwen He, Tao Li. Supplementation of enteral nutritional powder decreases surgical site infection, prosthetic joint infection, and readmission after hip arthroplasty in geriatric femoral neck fracture with hypoalbuminemia. J Orthop Surg Res 2019;14:292.
• Stone AV, Jinnah A, Wells BJ, Atkinson H, MillerAN, Futrell WM et al. Nutritional markers may identify patients with greater risk of re-admission after geriatric hipfractures. Int Orthop 2018;42:231-238.
• Chen Y, Wu X, Chen J, Wei X, Xi L, Wei H. et al. Nutritional condition analysis of the older adult patients with femoral neck fracture.Clin Nutr 2020;39:1174-1178.
• Foster MR, Heppenstall RB, Friedenberg ZB, Hozack WJ, A prospective assessment of nutritional status and complications in patients with fractures of the hip. J Orthop Trauma. 1990;4:49-57.
• Pioli G, Barone A, Giusti A, Oliveri M, Pizzonia M, Razzano M et al. Predictors of mortality after hip fracture: Results from 1-year follow-up. Aging Clin Exp Res 2006;18:381-387.
• Sullivan DH, Nelson CL, Klimberg VS. Bopp Nightly enteral nutrition support of elderly hip fracture patients: a pilot study. J Am Coll Nutr 2004;23:683-691.
• Aldebeyan S, Nooh A, Aoudea A, Weber MH, Harvey EJ. Hypoalbuminaemia a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures. İnjury 2017;48:436-440.
• Nicholson J, Dowrick A, Liew S. Nutritional status and short-term outcome of hip arthroplasty. J Orthop Surg 2012;20:331-335.
• Bohl DD, Shen M, Hannon CP, Fillingham YA, Darrith B, Della Valle CJ. Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture. J. Bone Joint Surg. Am 2017;99:2110-2118.
• Cabrerizo S, Cuadras D. Gomez-Busto F, Artaza-Artabe I, Marin-Ciancas F, Malafarina, V. Serum albumin and health in older people: Review and meta analysis. Maturitas 2015;81:17–27.
• O'Daly BJ, Walsh JC, Quinlan JF, Falk GA, Stapleton R, QuinlanW R et al. Serum albumin and total lymphocyte count as predictors of outcome in hip fractures.Clin Nutr 2010;29:89-93.
• Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Grosman B, Frishman S et al. The relationship between nutritional status of hip fracture operated elderly patients and their functioning,comorbidity and outcome. Clin. Nutr 2012;31:917–921.
• Koval KJ, Maurer SG, Su ET, Aharonoff G B, Zuckerman J D et al. The effects of nutritional status on outcome after hip fracture. J Orthop Trauma 1999;13:164-169.