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Original Paper |
Geriatric Research Education and Clinical Center (D.H.S., M.M.B.), John L. McClellan Memorial Veterans Hospital, Little Rock
Department of Orthopaedic Surgery (C.L.N.), University of Arkansas for Medical Sciences, Little Rock
Division of Biometry (R.C.W.), Department of Medicine, University of Arkansas for Medical Sciences, Little Rock
Criminal Justice Institute (C.L.P-M.), University of Arkansas at Little Rock, Little Rock, Arkansas
Address reprint requests to: Dennis H. Sullivan, MD, Geriatric Research Education and Clinical Center (182/LR), John L. McClellan Memorial Veterans’ Hospital, 4300 West 7th Street, Little Rock, AR 72205
Objective: This non-blinded randomized controlled trial was the first phase of a planned series of investigations designed to test the efficacy of aggressive post-operative enteral nutrition support to decrease the rate of post-operative complications or improve long-term outcomes in specifically defined subgroups of elderly patients who have sustained a hip fracture requiring surgery.
Methods: Eighteen patients (17 males) were randomized to the treatment (eight male subjects) or control groups. The control group (mean age 76.5±6.1 years) received standard post-operative care. Subjects in the treatment group (mean age 74.5±2.1 years) received 125 cc/hour of nasoenteral tube feedings over 11 hours each night in addition to standard post-operative nutritional care.
Results: Both the treatment and control groups had reduced volitional nutrient intakes for the first 7 post-operative days (3,966±2,238 vs. 4,263±2,916 kJ/day [948±535 vs. 1019±697 kcal/day], p=0.815), but the treatment subjects had a greater total nutrient intake (7,719±2,109 vs. 4,301±2,858 kJ/day [1845±504 vs. 1028±683 kcal], p=0.012). On average, treatment subjects were tube fed for 15.8±16.4 days. There was no difference between the groups (treatment vs. controls) in the rate of post-operative life-threatening complications (25 vs. 30%, p=1.00) or in-hospital mortality (0 vs. 30%, p=0.216). Mortality within 6 months subsequent to surgery was lower in the treatment group compared to the controls (0 vs. 50%, p=0.036).
Discussion: We conclude that nightly enteral feedings are a safe and effective means of supplementing nutrient intake. The greatest impact of nutrition support may be to reduce mortality.
Key words: elderly, hip fracture, protein-energy undernutrition, nutrition support, enteral feedings, randomized control trial
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