Der Einflussfaktor Ernährung auf die perioperative Rekonvaleszenz und Hospitalisationszeit nach proximaler Femurfraktur im Alter

Einleitung: Die proximale Femurfraktur zählt nicht nur zu den häufigsten Frakturen im hohen Alter, sondern darüber hinaus aufgrund ihrer erheblichen psychosozialen Folgen sowie hohen gesundheitsökonomischen Kosten zu den geriatrischen Verletzungen höchster Relevanz. Trotz aller Bemühungen sind die L...

Full description

Saved in:
Bibliographic Details
Main Author: Nitzge, Anja
Contributors: Lechler, Philipp (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2024
Subjects:
Online Access:PDF Full Text
Tags: Add Tag
No Tags, Be the first to tag this record!

Introduction: Proximal femoral fractures represent one of the most frequently observed fractures in the elderly patient, and should also be regarded as being one of the geriatric diseases of greatest significance due to the psychosocial consequences and considerable costs involved from a health-economics perspective. Despite the best efforts of many, results over the long term are not satisfactory. For those affected, these fractures will often mean their independence is impacted as a result. Complication and mortality rates continue to be as high as ever, underlining the great need for research and further developments with respect to optimizing patient outcomes. A deficient diet is of great significance when considering both how proximal femoral fractures occur and how patients recover following their injury. There are multiple causes for, and consequences of, a poor nutritional status. For example, deficient nutrition has been proven to be associated with occurrence of postoperative complications, hospital-acquired infections and wound-healing disorders. Multiple studies have also shown a correlation between malnutrition and increased length of inpatient stays, as well as increased healthcare costs. The mean length of inpatient stay for cases of femoral fracture in Germany is currently 12,92 days. If this admission duration could be shortened, it could mean not only a reduction in treatment costs, but also a reduction in hospital-acquired infections, and other risks. By contrast, the patient must be in a fit state to be discharged, with adequate pain control, early mobilization, and good wound healing that is free of signs of inflammation. For this reason, identifying the optimal time point for discharging patients remains challenging. Methods: As part of a prospective observational study, possible factors which could lead to a relative prolonging of patient stays and could influence the earliest potential time to patient discharge were investigated from 07.11.2013 to 30.10.2014, at the Clinic for Orthopedics and Trauma Surgery of the University Hospital Marburg. This involved a comparison of the actual time to discharge with the earliest potential discharge time. In this study, there was a particular focus on the role played by nutrition as malnutrition has been proven to affect patient outcomes. Patients’ nutritional status was recorded on the basis of BMI, serum albumin, and the MNA nutrition questionnaire. Additionally, patients were observed for their nutritional behaviors during the post-operative treatment period. Results: Analysis of this study showed a significant discrepancy of 3.7 days (SD = 3,7; p < 0,001) between the earliest potential time to discharge and the actual discharge time, whereby the mean duration of admission was 14.4 days (SD = 5,1). The patient population was representative of typical geriatric patients suffering from femoral fractures: it was an elderly, multimorbid patient group with a mean age of 81.9 years (SD = 7,6). Manifest malnutrition was detected in 10.2% of patients by BMI and 16.2% by MNA. An unexpected result was that the nutritional status (determined by BMI and MNA) did not show any significant effect on the earliest potential time to discharge. Between the other variables (ASA status, fracture type and dementia), only fracture type B2 and cognitive status correlated significantly with the earliest potential discharge time. A highly-significant correlation (p< 0,000) was detected between serum albumin and the earliest potential discharge time. Due to considerable influences by organic/medical factors on serum albumin levels, this parameter cannot be considered to be nutrition-specific. By contrast, with respect to patient outcomes, serum albumin levels were revealed to be a predictive measure for mortality and morbidity. Conclusion: With respect to the highly-significant correlation between serum albumin and the earliest potential time to discharge, this parameter could be taken into consideration as part of both planning and predicting the optimal time for patient discharge. The objective of future studies should be to identify further influencing factors which bring about a relative prolonging of duration of hospital length of stay. To ensure patient discharges can be organized in the most effective way, there is also a need for criteria and validated parameters which can shed light on the optimal time for discharge. Standardized discharge management of this type would lead to significant improvements to patient outcomes following proximal femoral fractures; costs in terms of healthcare economics could also be significantly reduced due to a reduction in unnecessary treatment times.