First-week postoperative caloric intake predicts mortality, complications and functional recovery in elderly patients with hip fracture and compromised nutritional status

OBJECTIVE: This study aimed to evaluate the impact of caloric deficiency during the first postoperative week on 60-day mortality, complication incidence and functional ambulatory recovery in elderly patients with hip fracture who are malnourished or nutritionally at risk. METHODS: A prospective observational study included 120 patients with surgically treated hip fracture aged > 65 years with preoperative malnutrition (Mini Nutritional Assessment - Short Form ≤ 11). Caloric intake was calculated using the Harris-Benedict equation, and patients were stratified into two groups: <60% or ≥ 60% of the caloric goals during the first postoperative week. Outcomes included 60-day mortality, postoperative complications (infectious, cardiovascular, delirium) and mobility levels. Logistic regression adjusted for covariates was used for analysis. RESULTS: The ≥ 60% caloric intake group exhibited significantly higher 60-day survival (93.98% vs. 72.97%, p = 0.004) and lower complication rates (38.55% vs. 75.68%, p < 0.001) than the < 60% group. Logistic regression analyses verified the reduced mortality risk (odds ratio [OR]: 0.129, 95% confidence interval [CI]: 0.02-0.70) and complication risk (OR: 0.225, 95% CI: 0.09-0.59) in the ≥ 60% group. Additionally, sufficient caloric intake was found to correlate with improved mobility (OR: 3.984, 95% CI: 1.54-10.31). CONCLUSION: Our study demonstrates that insufficient caloric intake during the first postoperative week is associated with elevated mortality risk, higher rates of postoperative complications and delayed functional recovery in elderly patients undergoing hip fracture surgery who are malnourished.