Einfluss einer Mangelernährung auf das Outcome nach hüftgelenksnaher Femurfraktur- Eine retrospektive, monozentrische Studie

Im Zuge des demografischen Wandels in Deutschland nimmt die Anzahl jüngerer Patienten ab und die Anzahl älterer Patienten zu. Die zunehmende Zahl älterer Menschen führt dazu, dass die Gruppe der geriatrischen Patienten in den Kliniken zunehmend größer wird und dementsprechend die Relevanz dieser Gru...

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Bibliographic Details
Main Author: Malek, Fahd
Contributors: Schöneberg, Carsten (Prof.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2023
Online Access:PDF Full Text
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Background: In the course of demographic change in Germany, the number of younger patients is decreasing, and the number of older patients is increasing. The increasing number of older people means that the group of geriatric patients in the clinic is growing and accordingly the relevance of this group is increasing in everyday clinical practice. With increasing age, the number of fractures increases significantly. Malnutrition in old age is a known risk factor for a higher rate of complications and mortality. The aim of the work is to determine the impact of malnutrition on the prognosis of hip fracture patients based on albumin and BMI. Methods: In the retrospective work, we analyzed data from all patients in the period 2017 to 2019 with a fracture of the proximal femur who were treated surgically. Complications and other treatment data were evaluated from hospital information systems and the respective patient chart. Patients with a fracture of the proximal femur who were 70 years of age or older were included. Patients who were missing their BMI, serum albumin value or had a periprosthetic fracture were not included. Results: A significant majority of patients with a BMI lower than 20 kg/m² were females. The hypoalbuminemia patient group had significantly higher ASA scores, higher Charlson Comorbidity Index scores, lower hemoglobin levels and lower prothrombin time. In patients with hypoalbuminemia, there was a significantly higher rate of mortality (10.3 % vs. 4.1 %, p = 0.02) and complications (57.9 % vs. 46.7 %, p = 0.04) compared to patients with a normal albumin level. In comparison, mortality and complications were not significantly higher in patients with a BMI below 20 kg/m² than in patients with a BMI above 20 kg/m². In addition, blood loss and the rate of red blood cell transfusions were higher in patients with hypoalbuminemia. Patients who had a BMI less than 20 kg/m² had an increased chance of needing for intraoperative cardiopulmonary resuscitation (2.6 % vs. 0.4 %, p = 0.05). However, the regression analysis was unable to support these findings. Conclusions: Patients who have a lower hemoglobin value, shorter prothrombin time, or higher ASA grade may be more susceptible to hypoalbuminemia. It is linked to a increased mortality rate and postsurgical complications. Compared to BMI, albumin is a more reliable parameter for determining the outcome after surgical treatment of a hip fracture. Albumin is not a standalone variable and should be considered in connection with other risk factors and comorbidities. Low albumin levels were linked to higher Charlson Comorbidity Index and ASA scores when compared to a BMI under 20 kg/m².