Those experiencing hip fractures are typically more prone to comorbidities, postoperative complications, and protein-energy malnutrition (Bell, Bauer, Capra, & Pulle, 2014; Foss, Jensen, & Kehlet, 2007). Many individuals fail to meet the appropriate amount of energy and protein during postoperative care. As a result, muscle wasting can occur and contribute to further deterioration of nutritional status and health outcomes (Bell, Bauer, Capra, & Pulle, 2014; Foss, Jensen, & Kehlet, 2007; Mahan & Raymond, 2017).
A review of literature conducted by Arkley, Dixon, Wilson, Charlton, Ollivere, & Eardley (2019), found numerous beneficial effects of adequate postoperative nutrition care. The reviews looked at the efficacy of an oral nutrition supplement (ONS) for the postoperative rehabilitation from hip surgery. The review reported implications for beneficial effects in numerous areas, which included: “total protein measurement, complications, and change in serum albumin levels” (Arkley, Dixon, Wilson, Charlton, Ollivere, & Eardley, 2019). A study completed by Duncan, Beck, Hood, & Johansen (2006), examined the effects of sitting with, encouraging, and sometimes feeding a patient for postoperative care. Some of the beneficial effects reported were a decrease in mortality, reduction in length of stay, prevention of further complications, and meeting adequate nutritional needs. Although it is important to note that these studies focused on elderly postoperative patients – it’s crucial to reiterate the importance of adequate nutrition in postoperative care. A study conducted by Hao, Schlussel, Carson, & Shapses (2019), examined the effects of vitamin D levels on effects of mobility and mortality regarding hip fractures. The study reported that those who had higher levels of vitamin D, compared to their deficient counterparts, had an increased ability to walk at about 30 and 60 days. The study however found no correlation with vitamin D and mortality.
Conversely, we must take into consideration the sedentary lifestyle associated with postoperative care, especially hip fractures. Many of the above studies examined the elderly, typically the major demographic of those who suffer from a hip fracture and must undergo hip surgery are females and elderly (Bell, Bauer, Capra, & Pulle, 2014). Prior to surgery some of the elderly patients may already have been malnourished and/or sedentary. However, for those who lived an active lifestyle prior, may experience decreased caloric needs (Mahan & Raymond, 2017). What is especially crucial is maintaining muscle mass, while limiting undesirable weight loss/gain during the postoperative phase (Mahan & Raymond, 2017). Removing any barriers to receive adequate protein intake is necessary to prevent muscle wasting, nutritional deterioration, and improve healing time (Bell, Bauer, Capra, & Pulle, 2014; Mahan & Raymond, 2017).
The need to develop and preserve skeletal muscle mass is quintessential for overall health, quality of life, and wound healing (Dideriksen, Reitelseder, & Holm, 2013; Mahan & Raymond, 2017). The skeletal muscle plays a key role in energy consumption, storage, metabolism, and weight regulation (Dideriksen, Reitelseder, & Holm, 2013). Furthermore, the consumption and storage of proteins are crucial for making additional proteins within the body to combat comorbidities and aid in wound healing during illness and trauma (Dideriksen, Reitelseder, & Holm, 2013).
References
Arkley, J., Dixon, J., Wilson, F., Charlton, K., Ollivere, B. J., & Eardley, W. (2019). Assessment of Nutrition and Supplementation in Patients With Hip Fractures. Geriatric Orthopaedic Surgery & Rehabilitation, 10, 215145931987980. doi:10.1177/2151459319879804
Bell, J. J., Bauer, J. D., Capra, S., & Pulle, R. C. (2014). Multidisciplinary, multi-modal nutritional care in acute hip fracture inpatients – Results of a pragmatic intervention. Clinical Nutrition, 33(6), 1101-1107. doi:10.1016/j.clnu.2013.12.003
Dideriksen, K., Reitelseder, S., & Holm, L. (2013). Influence of Amino Acids, Dietary Protein, and Physical Activity on Muscle Mass Development in Humans. Nutrients, 5(3), 852-876. doi:10.3390/nu5030852
Duncan, D. G., Beck, S. J., Hood, K., & Johansen, A. (2006). Using dietetic assistants to improve the outcome of hip fracture: A randomised controlled trial of nutritional support in an acute trauma ward. Age and Ageing, 35(2), 148-153. doi:10.1093/ageing/afj011
Foss, N. B., Jensen, P. S., & Kehlet, H. (2007). Risk factors for insufficient perioperative oral nutrition after hip fracture surgery within a multi-modal rehabilitation programme. Age and Ageing, 36(5), 538-543. doi:10.1093/ageing/afm079
Hao, L., Schlussel, Y., Carson, J., & Shapses, S. (2019). Vitamin D Levels and Nutritional Risk Index: Mobility and Mortality After Hip Fracture Surgery (P01-013-19). Current Developments in Nutrition, 3(Supplement_1). doi:10.1093/cdn/nzz028.p01-013-19
Mahan, L. K., & Raymond, J. L. (2017). Krauses food & the nutrition care process. St. Louis, MO: Elsevier.
