The effect of perioperative nutritional therapy on the cognitive functions and nutritional status in elderly patients with femoral neck fracture

Aim: Femoral neck fracture is a common condition in the elderly. The catabolic state due to the neurohumoral response and poor nutrition is a threat to the fitness, immune system and cognitive functions in this age group. This study investigated the effect of a pragmatic nutritional therapy on laboratory markers of nutritional status, cognitive functions and postoperative complications in elective geriatric patients with femoral neck fracture. Materials and Methods: A total of 47 patients were randomized into two groups: Study group was audited two times a day to ensure administration of 30 kcal/kg/day calorie and 1 kg/day protein. Control group received standard hospital care. Complete blood count and routine biochemistry tests, Mini mental test scores and triceps skinfold thickness were obtained at the day of admission to the study, before the day of surgery and on the 5th postoperative day. Blood products and postoperative complications were recorded. Results: Postoperative Mini mental test scores were lower in the study group (p

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1. Aykaç ZZ, Arslantaş MK. Sıvı Tedavisi ve Yönetimi. GKDA Derg. 2017;23(2):35-42.
2. Erol DD. Perioperatif sıvı tedavisi: Güncel yaklaşımlar. T Klin J Med Sci. 2007;27(6):894-901.
3. Cengiz M. Geriatrik Hastalarda Ameliyata Hazırlık ve Anestezi. Turkiye Klinikleri J Orthop & Traumatol-Special Topics. 2008;1(2):61-8.
4. Shim HJ, Jang JY, Lee SH, et al. The effect of positive balance on the outcomes of critically ill noncardiac postsurgical patients: a retrospective cohort study. J Crit Care. 2014;29(1):43-8.
5. Yin K, Ding J, Wu Y, et al. Goal-directed fluid therapy based on noninvasive cardiac output monitor reduces postoperative complications in elderly patients after gastrointestinal surgery: A randomized controlled trial. Pak J Med Sci. 2018;34(6):1320-5.
6. Nikkel LE, Fox EJ, Black KP, et al. Impact of Comorbidities on Hospitalization Costs Following Hip Fracture. J Bone Joint Surg Am. 2012;94(1):9-17.
7. Partridge JS, Harari D, Martin FC, et al. The impact of preoperative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review. Anaesthesia. 2014;69(1):8-16.
8. Preston SD, Southall ARD, Nel M, et al. Geriatric surgery is about disease, not age. J Roy Soc Med. 2008;101(8):409-15.
9. Holte K, Klarskov B, Christensen DS, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg. 2004;240(5):892.
10. Güngen C, Ertan T, Eker E, et al. Standardize mini mental test’in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Turk Psikiyatri Derg. 2002;13:273-81.
11. Ucuzal M. Yaşlı hastalarda ameliyat sonrası bilişsel değişiklikler. Turkish J Geriatrics. 2008;11:119-27.
12. Bauer JM, Wirth R, Troegner J, et al. Ghrelin, anthropometry and nutritional assessment in geriatric hospital patients. Z Gerontol Geriatr. 2007;40:31-6.
13. Bruce D, Laurance I, McGuiness M, et al. Nutritional supplements after hip fracture: poor compliance limits effectiveness. Clin Nutr. 2003;22(5):497-500.
14. Kruizenga HM, Van Tulder MW, Seidell JC, et al. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr. 2005;82(5):1082-9.
15. Lin HS, Watts JN, Peel NM, et al. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157.
16. Veiga-Gil L, Pueyo J, López-Olaondo L. Postoperative nausea and vomiting: physiopathology, risk factors, prophylaxis and treatment. Rev Esp Anestesiol Reanim. 2017;64(4):223-32.
17. Lawson RM, Doshi MK, Barton JR, et al. The effect of unselected post-operative nutritional supplementation on nutritional status and clinical outcome of orthopaedic patients. Clin Nutr. 2003;22(1):39-46.
18. Lawson RM, Doshi MK, Ingoe LE, et al. Compliance of orthopaedic patients with postoperative oral nutritional supplementation. Clin Nutr. 2000;19(3):171-5.
19. BAPEN. Nutrition Screening Surveys in Hospitals in the UK, 2007-2011. https://www.bapen.org.uk/pdfs/nsw/bapennsw-uk.pdf access date 15.07.2020
20. Kondrup J, Rasmussen HH, Hamberg O, et al. Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-36.
21. Macfie D, Zadeh RA, Andrews M, et al. Perioperative multimodal optimisation in patients undergoing surgery for fractured neck of femur. Surgeon. 2012;10(2):90-4.
22. Köse O, Budak S, Aydemir H, et al. Radikal Sistektomi Yapılan Hastalarda Preoperatif Oral Destek Nutrisyonun Cerrahi İyileşmeye Etkisi. The Cystoscope. 2014;136-40.
23. Stratton RJ, Elia M. Who benefits from nutritional support: what is the evidence? Eur J Gastroenterol Hepatol. 2007;19:353- 8.
24. Bruce D, Laurance I, McGuiness M, et al. Nutritional supplements after hip fracture: poor compliance limits effectiveness. Clin Nutr. 2003;22(5):497-500.
25. Staudacher HM, Irving PM, Lomer MCE, et al. The challenges of control groups, placebos and blinding in clinical trials of dietary interventions. Proc Nutr Soc. 2017;76(3):203-12.
26. Barrimore SE, Rapchuk IL, Pulle RC, et al. Even preoperative carbohydrate loading is too hard? Why RCT’s should not be considered the gold standard for nutrition research in acute hip fracture: results of a feasibility study. Int J Clin Trials. 2019;6(3):89-95.
27. Feinberg J, Nielsen EE, Korang SK, et al. Nutrition support in hospitalised adults at nutritional risk. Cochrane Database Syst Rev. 2017;5(5):CD011598.