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The Journal of Bone and Joint Surgery, Vol 74, Issue 2 251-260, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Protein depletion and metabolic stress in elderly patients who have a fracture of the hip
BM Patterson, CN Cornell, B Carbone, B Levine and D Chapman
Cornell University Medical Center, Hospital for Special Surgery-New York Hospital Fracture Service, N.Y. 10021.
A prospective study was performed to determine the effect of protein
depletion and postoperative nutritional status on the outcome in
sixty-three elderly patients who had been admitted to the hospital because
of a fracture of the hip. The parameters that were used to determine the
degree of protein depletion included levels of albumin, of prealbumin, and
of transferrin; total lymphocyte count; and nitrogen-balance studies. The
outcomes that were examined were the development of complications, the
length of the stay in the hospital, the ability to return to the
pre-fracture level of function, and over-all survivorship. The hypothesis
was that the acute fracture and the subsequent operation are severe
stresses in these elderly, often compromised patients. The results
supported the hypothesis. Thirty-seven patients (58 per cent) in the study
group were in a protein-depleted state during the period of
hospitalization. The patients who were protein-depleted had a higher
prevalence of complications, were less likely to return to their
pre-fracture environment, and tended to stay in the hospital longer, as
compared with the nonprotein-depleted patients. Survivorship analysis
showed that protein-depleted patients had a significantly lower probability
of survival one year after the fracture of the hip (p = 0.02). Elderly
patients who sustain the trauma of a fracture of the hip should be managed
appropriately with regard to intake of nutrients in the postoperative
period.
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