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Nightly Enteral Nutrition Support of Elderly Hip Fracture Patients: A Pilot Study

Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System (D.H.S.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
Donald W. Reynolds Department of Geriatrics (D.H.S., M.M.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
Department of Orthopaedic Surgery (C.L.N.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
Departments of Surgery and Pathology (V.S.K.), University of Arkansas for Medical Sciences, Little Rock, Arkansas

Address reprint requests to: Dennis H. Sullivan, M.D., Geriatric Research Education and Clinical Center (182/LR), Central Arkansas Veterans Healthcare System, 4300 West 7th Street, Little Rock, AR 72205. E-mail: sullivandennish{at}uams.edu

Objectives: Assess whether postoperative nightly enteral nutrition support improves outcomes of elderly patients with an acute hip fracture

Design: Randomized controlled trial

Setting: A University and a Department of Veteran’s Affairs Hospital

Subjects: Adults >64 years of age who underwent surgical repair of an acute hip fracture

Interventions: Subjects randomized to the control (Ctrl) group received standard care while the treatment (Tx) group received standard care plus up to 1,375 Kcal [5,755 kJ/d] of nasoenteral tube feedings each night. When tube feedings had to be discontinued, Tx subjects were asked to drink an equivalent amount of the nutritional supplement each night.

Measures of Outcome: Rate of postoperative complications and 6-month postoperative survival

Results: Fifty-seven patients were randomized to the Tx (n = 27, mean age 75.9 ± 7.4 yrs) or Ctrl groups (age 81.7 ± 7.7 yrs). All subjects had reduced volitional nutrient intakes after surgery. During the first week subsequent to surgery, there was no difference between the treatment and control groups in the amount of nutrients that they volitionally consumed during the day. However, the treatment subjects had a greater total daily nutrient intake (Median 5,866 (IQR 5,024 to 7,335) kJ/d vs. 3,965 (IQR 2,968 to 4,664) kJ/d, p < 0.001). However, by the second postoperative week this difference was no longer statistically significant. Intolerance to the tube feedings developed commonly. There was no difference between the groups in the rate of postoperative life-threatening complications or mortality within six months subsequent to surgery.

Conclusions: This study failed to confirm findings from a prior study of improved postoperative survival with nutrition support. However, it was conducted on multiple hospital wards which may have contributed to the higher rate of tube-related problems and less nutrient delivery signifying the need for further study.

Key words: elderly, hip fracture, nutrition support, protein-energy undernutrition, enteral feedings, randomized controlled trial