Malnutrition is a potentially modifiable risk factor that may contribute to complications following geriatric hip fracture surgery. The purpose of this study was to investigate the association between preoperative hypoalbuminemia, a marker for malnutrition, and complications during the thirty days following surgery for geriatric hip fracture. The American College of Surgeons National Surgical Quality Improvement Program was used to conduct a retrospective cohort study of geriatric patients (>65 years) undergoing surgery for hip fracture. Patients without preoperative serum albumin concentration were excluded. Outcomes were compared between patients with and without hypoalbuminemia (defined as serum albumin concentration <3.5g/dL). All comparisons were adjusted for baseline differences between populations. 17,651 Patients were identified. Of these, 8,272 (46.9%) underwent hemiarthroplasty, 759 (4.3%) total joint arthroplasty, 324 (1.9%) percutaneous fixation, 2,445 (13.9%) plate/screw fixation, and 5,833 (33.1%) intramedullary fixation. The prevalence of hypoalbuminemia was 45.9% (Figure 1). The risk for death was strongly associated with serum albumin concentration, with a linear increase in risk observed as albumin fell below 3.5 g/dL (p<0.001; Figure 2). Following adjustment for all demographic, comorbidity, and procedural characteristics, patients with hypoalbuminemia had higher rates of death (9.94% versus 5.53%, adjusted relative risk [RR]=1.54, p<0.001), pneumonia (5.30% versus 3.77%, adjusted RR=1.20, p=0.012), sepsis (1.19% versus 0.53%, adjusted RR=1.90, p<0.001), and hospital readmission (10.91% versus 9.03%, adjusted RR=1.11, p<0.036; Table 1). The present study suggests that hypoalbuminemia is a powerful independent risk factor for death following surgery for geriatric hip fracture. This association persists over-and-above any associations of death with age, sex, body mass index, and comorbidities. Based on these data, we propose that the nutritional status of hip fracture patients should receive greater attention, and that randomized trials testing for efficacy of aggressive postoperative nutritional interventions may be warranted. For any figures or tables, please contact the authors directly by clicking on ‘Info & Metrics’ above to access author contact details

Introduction. While interdisciplinary protocols and expedited surgical treatment improve management of geriatric hip fractures, the impact of such interventions on patients undergoing specifically arthroplasty for femoral neck fracture (FNF) has not been well studied. The aim of this study is to evaluate the efficacy of an interdisciplinary hip fracture protocol for patients undergoing arthroplasty for acute FNF. Methods. In 2017, our tertiary care institution implemented a standardized interdisciplinary hip fracture protocol. We conducted a retrospective review of adult patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for FNF from July 2012 – March 2020, and compared patient characteristics, hospitalization characteristics, and outcomes between those treated before and after protocol implementation. Results. 157 patients were treated before implementation (22.3% THA), and 114 patients were treated after implementation (32.5% THA). Demographics and medical comorbidities were similar before and after protocol implementation. Patients who underwent HA were older (82.1 vs 71.1 years, p<0.001), more medically complex (Charlson Comorbidity Index 6.4 vs 4.1, p<0.001), and more likely to develop delirium (8.5% vs 0%, p=0.024) than those who underwent THA. Patients treated after implementation had reduced time between admission and operative management (24.1 vs 46.5 hours, p=0.042), decreased rate of major complications (0% vs 12.7%, p<0.001), decreased hospital length of stay (LOS) (5.2 vs 6.4 days, p=0.008), increased rate of discharge to home (26.3% vs 14.7%, p=0.03), and decreased 365-day mortality (14.6% vs 26.1%, p=0.049). There were no significant differences between post-protocol and pre-protocol, respectively, 90-day readmission (18.2% vs 21.7%, p=0.53) or 30-day mortality (3.7% vs 5.1%, p=1.0). Conclusion. This interdisciplinary protocol reduced time to operative management, hospital LOS, in-hospital complications, and one-year mortality for patients who underwent arthroplasty for FNF, without increasing readmission or non-home discharge. Such interventions are critical in improving outcomes and reducing costs for an aging population