Nutritional optimization for older adults undergoing hip fracture surgery: a randomized controlled pilot trial.

Abstract

To identify the incidence of malnutrition in elderly patients with hip fracture, evaluate the impact of a nutritional intervention, and assess feasibility of study design. Randomized controlled pilot trial. Level 1 trauma center. Forty patients ≥65 years undergoing hip fracture surgery were randomized 1:1 to receive standard care or nutritional intervention. Standard perioperative care versus comprehensive nutritional intervention. Study feasibility, using the RE-AIM framework, was the primary outcome. Tracked metrics included recruitment and retention rate, loss-to-follow-up (LTFU), and medication/laboratory compliance. The clinical outcomes measured were reoperation, readmissions, mortality, grip strength, health-related quality of life, and medical complications. Recruitment rate (64%), improving after implementation of surgeon enrollment and inclusion of dementia patients. Retention rate was 60%, with LTFU primarily because of visit frequency and transportation barriers. Medication and laboratory compliance were poor. All patients had ≥1 deficient nutritional serum marker at baseline. One reoperation occurred in each group. Readmissions were higher in the standard care group (n = 3) versus intervention group (n = 2). One death occurred in the intervention group and 3 in the standard care group. Grip strength increased 2.6 pounds in the intervention group. Nutritional deficiencies are prevalent among patients with geriatric hip fracture. Study feasibility was demonstrated, but LTFU exceeding 20% necessitates targeted enrollment and retention strategies. This study informs a subsequent larger, multicenter randomized controlled trial and provides critical insights into optimal study design and execution. Level II; pilot randomized controlled trial.