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Meta-Analysis
. 2023 Nov 1;105-B(11):1149-1158.
doi: 10.1302/0301-620X.105B11.BJJ-2023-0139.R1.

Effect of oral nutritional supplementation on outcomes in older adults with hip fractures and factors influencing compliance

Bin Chen  1   2 , Jia H Zhang  1 , Andrew D Duckworth  2   3 , Nick D Clement  2
Affiliations
Meta-Analysis

Effect of oral nutritional supplementation on outcomes in older adults with hip fractures and factors influencing compliance

Bin Chen et al. Bone Joint J. .

Abstract

Aims: Hip fractures are a major cause of morbidity and mortality, and malnutrition is a crucial determinant of these outcomes. This meta-analysis aims to determine whether oral nutritional supplementation (ONS) improves postoperative outcomes in older patients with a hip fracture.

Methods: A systematic literature search was conducted in August 2022. ONS was defined as high protein-based diet strategies containing (or not containing) carbohydrates, fat, vitamins, and minerals. Randomized trials documenting ONS in older patients with hip fracture (aged ≥ 50 years) were included. Two reviewers evaluated study eligibility, conducted data extraction, and assessed study quality.

Results: There were 812 studies identified, of which 18 studies involving 1,522 patients met the inclusion criteria. The overall meta-analysis demonstrated that ONS was associated with significantly elevated albumin levels (weighted mean difference (WMD) 1.24 (95% confidence interval (CI) 0.95 to 1.53)), as well as a significant risk reduction in infective complications (odds ratio (OR) 0.54 (95% CI 0.39 to 0.76)), pressure ulcers (OR 0.54 (95% CI 0.33 to 0.88)), and total complications (OR 0.57 (95% CI 0.42 to 0.79)). Length of hospital stay (LOS) was also significantly reduced (WMD -2.36 (95% CI -4.14 to -0.58)), particularly in rehabilitation LOS (WMD -4.17 (95% CI -7.08 to -1.26)). There was a tendency towards a lower mortality risk (OR 0.93 (95% CI 0.62 to 1.4)) and readmission (OR 0.52 (95% CI 0.16 to 1.73)), although statistical significance was not achieved (p = 0.741 and p = 0.285, respectively). The overall compliance with ONS ranged from 64.7% to 100%, but no factors influencing compliance were identified.

Conclusion: This meta-analysis is the first to quantitatively demonstrate that ONS could nearly halve the risk of infective complications, pressure ulcers, total complications, as well as improve serum albumin and reduce LOS. ONS should be a regular and integrated part of the perioperative care of these patients, especially given that the compliance with ONS is acceptable.

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Conflict of interest statement

B. Chen's living stipend in the UK was covered by the China Scholarship Council. N. D. Clement is an Editorial Board member of The Bone & Joint Journal and Bone & Joint Research. A. D. Duckworth reports research grants from NIHR, OTA, and SORT-IT, book royalties from Taylor & Francis and Elsevier, lecture and educational event payments from AgnNovos Healthcare, Swemac, and Smith & Nephew, and department research grants from Stryker, Smith & Nephew, and Acumed, all of which are unrelated to this study. A. D. Duckworth is also an Editorial Board member of The Bone & Joint Journal, Bone & Joint Research, and Bone & Joint 360, Associate Editor of Trials, OTAI, and JBJS Case Connector, and a member of the OTA and OTS Research Committees.

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