Inadequate Postoperative Energy Intake Relative to Total Energy Requirements Diminishes Acute Phase Functional Recovery From Hip Fracture

Abstract

ObjectiveTo investigate whether postoperative voluntary energy intake (EI) affects functional recovery with hip fracture during the acute phase. DesignProspective cohort study. SettingThree acute care hospitals. ParticipantsHip fracture patients (N=200) who were consecutively admitted to 3 acute hospitals because of falling. InterventionsNot applicable. Main Outcome MeasuresPatients were stratified into 3 groups based on the ratio of measured EI to estimated total energy expenditure (TEE) as inadequate (EI/TEE<0.7), intermediate (0.7≤EI/TEE<1), and adequate (EI/TEE≥1) groups. The functional status was evaluated using the motor domain of a FIM. We calculated efficiency based on the motor FIM scores (change in postoperative motor FIM scores/length of the rehabilitation period) to assess the beneficial effect of rehabilitation. ResultsThe median hospital stay was 24 days. The inadequate group comprised 73 (36.5%) patients (median EI/TEE, 0.54; interquartile range, 0.42-0.64); intermediate group comprised 92 (46.0%) patients (median EI/TEE, 0.87; interquartile range, 0.78-0.94), and adequate group comprised 35 (17.5%) patients (median EI/TEE, 1.10; interquartile range, 1.04-1.15). Absolute functional gain (AFG) and efficiency of motor FIM gain (EFG) scores were higher in the adequate group than in the others (P<.01). After adjustment for potential confounders, a significant association between postoperative EI/TEE group and logarithm of EFG scores was observed to persist (inadequate group, standardized β =−0.14; reference: adequate group; P=0.03; R2 for the entire model =0.25). ConclusionsPostoperative EI that is less than 70% of TEE diminishes functional recovery with hip fracture.