Abstract：【Objective】To explore the predictive efficacy of different nutritional screening tools on the postoperative outcomes of elderly hip fractures.【Methods】Clinical data of 314 patients who were hospitalized in the orthopedics department of the Zhangjiakou Second Hospital from January 2017 to December 2019 were collected. All patients were evaluated for their nutritional status using the Nutrition Risk Screening 2002 (NRS-2002), the malnutrition universal screening tool (MUST), the mini nutrition assessment-short form(MNA-SF), and the geriatric nutrition risk index (GNRI) before surgery. All patient clinical data were recorded, and the function independent measure (FIM) scale was used to evaluate daily living activities on the first day after surgery and at discharge. The FIM rehabilitation efficacy was calculated [(difference in FIM scores on the first day after surgery and discharge)/postoperative hospital stay], and the average walking speed of 15 meters at 14 days after surgery was evaluated. The correlation analysis between different nutritional status and prognostic indicators of various nutritional screening tools was conducted.【Results】A total of 343 patients were admitted, of which 29 were excluded and 314 met the inclusion criteria. The age was (81.54±7.34) years old, with 236 females (75.16%). According to MNA-SF nutritional screening, 80 cases (25.48%) were well nourished, 160 cases (50.96%) were at risk of malnutrition, and 74 cases (23.57%) were at risk of malnutrition; According to MUST nutritional screening, 145 cases (46.18%) were at low risk, 72 cases (22.93%) were at medium risk, and 97 cases (30.89%) were at high risk; According to NRS-2002 nutritional screening, 135 cases (42.99%) were well nourished, 101 cases (32.17%) had moderate risk, and 78 cases (24.84%) had malnutrition; According to GNRI nutritional screening, 68 cases (21.66%) were at no risk, 114 cases (36.31%) had mild risk, and 132 cases (42.04%) had significant risk. There was a statistically significant difference in the proportion of different nutritional status among various screening tools (χ2=45.82, P<0.001). There was a correlation between MNA-SF and discharge FIM score; Compared with good nutrition, both the risk of malnutrition and malnutrition had a negative impact on the discharge FIM score,FIM rehabilitation efficacy and average walking speed of 15 meters (P<0.05). NRS-2002 was only related to the discharge FIM score. When using GNRI evaluation, compared with no risk, minor and major risks only had a negative impact on the average walking speed of 15 meters (P<0.05), and were not correlated with the rehabilitation efficacy of FIMs and the average walking speed of 15 meters (P>0.05).There was no correlation between MUST and prognostic indicators (P>0.05).【Conclusion】In the acute phase of elderly patients with hip fractures, MNA-SF is the most relevant nutritional screening tool for early functional prognosis.
赵玉婷, 郝龙英, 王金荣. 不同营养筛查工具对老年髋部骨折术后结局的预测效能*[J]. 医学临床研究, 2024, 41(5): 653-657.
ZHAO Yuting, HAO Longying, WANG Jinrong. The Predictive Efficacy of Different Nutritional Screening Tools on Postoperative Outcomes of Elderly Hip Fractures. JOURNAL OF CLINICAL RESEARCH, 2024, 41(5): 653-657.
[1] ZHANG C G, FENG J G,WANG S F, et al. Incidence of and trends in hip fracture among adults in urban China:a nationwide retrospective cohort study[J].PLoS Med,2020, 17(8): e1003180. [2] LOTUS SHYU Y L, CHEN M C, LIANG J, et al. Predictors of functional recovery for hip fractured elders during 12 months following hospital discharge: a prospective study on a Taiwanese sample[J].Osteoporos Int,2004, 15(6): 475-482. [3] DUBLJANIN-RASPOPOVIĆ E, MARKOVIĆ-DENIĆ L, MARINKOVIĆ J, et al. Does early functional outcome predict 1-year mortality in elderly patients with hip fracture?[J].Clin Orthop Relat Res,2013, 471(8): 2703-2710. [4] ANBAR R, BELOOSESKY Y, COHEN J, et al. Tight calorie control in geriatric patients following hip fracture decreases complications: a randomized, controlled study[J].Clin Nutr,2014, 33(1): 23-28. [5] INOUE T, MISU S, TANAKA T, et al. Pre-fracture nutritional status is predictive of functional status at discharge during the acute phase with hip fracture patients: A multicenter prospective cohort study[J].Clin Nutr,2017, 36(5): 1320-1325. [6] SÁNCHEZ SÁNCHEZ E, LÓPEZ-ALIAGA I, MUÑOZ ALFÉREZ M J. Analysis of three methods of nutritional screening in oncologic patients[J].Nutr Hosp,2018, 35(6): 1324-1330. [7] ZHAO A L, GE N,XIE D M, et al. The geriatric nutrition risk index versus the mini-nutritional assessment short form in predicting postoperative delirium and hospital length of stay among older non-cardiac surgical patients: a prospective cohort study[J].BMC Geriatr,2020, 20(1): 107. [8] 朱菲, 张灿芝, 丁琼, 等. 胃肠恶性肿瘤患者术后行肠外营养治疗预防低血糖发生的相关循证方法[J].医学临床研究, 2023, 40(2): 261-264. [9] JIA Z Y, EL MOHEB M, NORDESTGAARD A, et al. The Geriatric Nutritional Risk Index is a powerful predictor of adverse outcome in the elderly emergency surgery patient[J].J Trauma Acute Care Surg,2020, 89(2): 397-404. [10] 徐飞, 刘玮, 孙歆, 等. 营养风险评估指导下个性化营养方案在老年直肠癌术后患者中的应用价值[J].医学临床研究, 2023, 40(7): 1107-1109. [11] RUBENSTEIN L Z, HARKER J O, SALVÀ A, et al. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF)[J].J Gerontol A Biol Sci Med Sci,2001, 56(6): M366-M372. [12] KONDRUP J, ALLISON S P, ELIA M, et al. ESPEN guidelines for nutrition screening 2002[J].Clin Nutr,2003, 22(4): 415-421. [13] KOREN-HAKIM T, WEISS A,HERSHKOVITZ A. Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients[J].Clin Nutr,2017, 36(3): 912. [14] BOUILLANNE O, MORINEAU G, DUPONT C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients[J].Am J Clin Nutr,2005, 82(4): 777-783. [15] CEREDA E, PUSANI C, LIMONTA D, et al. The ability of the Geriatric Nutritional Risk Index to assess the nutritional status and predict the outcome of home-care resident elderly: a comparison with the Mini Nutritional Assessment[J].Br J Nutr,2009, 102(4): 563-570. [16] PASHMDARFARD M, AZAD A. Assessment tools to evaluate Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older adults: a systematic review[J].Med J Islam Repub Iran,2020, 34:33. [17] RYABYKH S O, PAVLOVA O M, SAVIN D M, et al. Surgical management of myelomeningocele-related spinal deformities[J].World Neurosurgery, 2018, 112:e431-e441. [18] HELMINEN H, LUUKKAALA T, SAARNIO J, et al. Predictive value of the mini-nutritional assessment short form (MNA-SF) and nutritional risk screening (NRS2002) in hip fracture[J].Eur J Clin Nutr,2019, 73(1): 112-120. [19] WANG S K,LI J, WANG P, et al. Comparison of four nutritional screening tools for predicting postoperative adverse events following degenerative spinal deformity surgery[J].Spine,2024, 49(8):536-546.
2024, Vol. 41 
