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. 2022 Feb 16;14(4):820.
doi: 10.3390/nu14040820.

Postoperative Dehydration Is Associated with Frailty and Decreased Survival in Older Patients with Hip Fracture

Michela Zanetti  1 , Paolo De Colle  2 , Cinzia Omiciuolo  2 , Chiara Ratti  3 , Gianluca Gortan Cappellari  4 , Rocco Barazzoni  1 , Luigi Murena  3 , Gianfranco Sanson  4
Affiliations

Postoperative Dehydration Is Associated with Frailty and Decreased Survival in Older Patients with Hip Fracture

Michela Zanetti et al. Nutrients. .

Abstract

Background: Hyperosmolar dehydration (HD) is a risk factor for severe complications in hip fracture in older patients. However, evidence for recommending screening of dehydration is insufficient and its relation with frailty and mortality is unclear. We tested the hypothesis that postoperative HD is associated with frailty and increased mortality.

Methods: We recruited 625 older (>65 years) patients surgically treated for hip fracture and co-managed by an orthogeriatric team over one year in 2017. Pre- and postoperative HD (serum osmolarity > 300 mmol/L) was diagnosed. Frailty and associated mortality risk were assessed by the Multidimensional Prognostic Index (MPI).

Results: The prevalence of preoperative HD was 20.4%. Compared with no-HD, MPI was similar in HD patients despite higher (p < 0.05) prevalence of polypharmacy, arterial hypertension, diabetes, chronic kidney disease and heart failure. After surgery the incidence of HD decreased to 16.5%, but increased (p = 0.003) in the MPI high-risk subgroup. Postoperative HD was associated with more complications and was an independent determinant of adjusted hospital length of stay (LOS) and of 60- to 365-days mortality.

Conclusions: Older frail patients with hip fracture are prone to developing postoperative HD, which independently predicts prolonged hospital LOS and mortality. Systematically screening older patients for frailty and dehydration is advisable to customize hydration management in high-risk individuals.

Keywords: dehydration; frailty; hip fracture; older; orthogeriatric care.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the participants’ selection process.
Figure 2
Figure 2
Modification in HD prevalence before and after surgery according to MPI groups.
Figure 3
Figure 3
Crude (a) and adjusted (b) Kaplan–Meier one-year survival curves for patients with or without postoperative hyperosmolar dehydration.
See this image and copyright information in PMC

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