This study aimed to find out whether the nutritional status at the time of admission of patients with femoral neck fractures affects rehabilitation outcomes during their hospital stay.
A retrospective analysis was conducted using medical records of 175 patients (43 men, 132 women; mean age 80 ± 9 years) admitted to an acute care hospital for surgery and rehabilitation between January 2019 and December 2021. Patients with weight-bearing restrictions or incomplete data were excluded. Parameters assessed included age, sex, Body Mass Index (BMI), Prognostic Nutritional Index (PNI) at admission, provided energy intake, provided protein intake, cognitive function, psychiatric disorders, and rehabilitation progress at the start, one week, and two weeks after surgery. Rehabilitation outcomes divided into 8 stages, and these stages were categorized into three groups: (1)Bedside, (2)Wheelchair, and (3)Walking.
The ethical considerations for this study were approved by the ethical review committee of the affiliated institution. In addition, the data was anonymized so that individuals could not be identified, and care was taken to ensure that the data was not leaked.
Among the 175 patients, 71 were in Group 1 (Bedside), 104 in Group 2 (Wheelchair), and none in Group 3 (Walking) at the start of rehabilitation. The analysis focused on 71 patients in Group 1. Two weeks after surgery, 52 patients improved to walking within parallel bars (improvement group), while 19 showed no improvement (non-improvement group). There were no significant differences in PNI or BMI between the two groups. A decision tree analysis was performed using factors such as age, sex, cognitive function, PNI, provided energy intake, and provided protein intake to explanatory variable to improvement.
Patients provided energy intake 24.9 kcal/kg (standard body weight) or more showed a 79.7% improvement rate (51/64), while those with lower energy had only a 14.2% improvement rate (1/7). Among those with 24.9 kcal/kg or more, patients with a PNI of 36.2 or higher had a 93.3% improvement rate (28/30), compared to 67.6% (23/44) for those with a PNI less than 36.2.
The rehabilitation outcome for patients starting at a bedside level was closely related to provided energy intake and nutritional status.
It was suggested that a nutritional approach is important in the rehabilitation after femoral neck fracture surgery.
femoral neck fractures
acute care hospitals
