Tight calorie control in geriatric patients following hip fracture decreases complications: a randomized, controlled study

Abstract

Background & aims: Optimizing nutritional intake has been recommended for geriatric patients undergoing hip-fracture surgery. Whether nutritional support guided by repeated measurements of resting energy requirements (REE) improves outcomes in these patients is not known.

Methods: A randomized, controlled, unblinded, prospective, cohort study comparing provision of energy with a goal determined by repeated REE measurements using indirect calorimetry, with no intervention. Oral nutritional supplements were started 24 h after surgery and the amount adjusted to make up the difference between energy received from hospital food and measured energy expenditure.

Results: 50 Geriatric patients were included in the study. Patients in the intervention group (n = 22) received significantly higher daily energy intake than the control group (n = 28) (1121.3 ± 299.0 vs. 777.1 ± 301.2 kcal, p = 0.001). This was associated with a significantly less negative cumulative energy balance (-1229.9 ± 1763 vs. -4975.5 ± 4368 kcal, p = 0.001). A significant negative correlation was found between the cumulative energy balance and total complication rate (r = -0.417, p = 0.003) as well as for length of hospital stay (r = -0.282, p = 0.049).

Conclusion: We have demonstrated that nutritional support actively supervised by a dietician and guided by repeated measurements of REE was achievable and improved outcomes in geriatric patients following surgery for hip fractures. Clinicaltrials.gov Identifier: NCT017354435.

Keywords: CAM; CCI; CIRS-G; Charlson's comorbidity index; Confusion Assessment Method; Cumulative Illness Rating Scale for Geriatrics; Energy expenditure; FIM; Functional Independence Measure; Geriatric; Hip fracture; IC; MAC; MMSE; MNA; Mini-Mental State Examination; ONS; Tight calorie control; indirect calorimetry; mid-arm circumference; mini-nutritional assessment; oral nutritional supplements.