Influence of preoperative diagnosis of nutritional disorders on short-term outcomes after hip arthroplasty: A cohort study of older adults.

Abstract

Background: Nutritional disorders may affect short-term recovery after major orthopaedic surgery, but evidence is lacking. This study assessed whether and how different nutritional disorders diagnosed at admission could influence early recovery after hip replacement. Methods: A prospective analytical study was designed to include 60 patients scheduled for elective primary hip replacement and assess their nutritional status to diagnose 5 malnutrition phenotypes: undernutrition, sarcopenia, obesity, sarcopenic obesity, and sarcopenic undernutrition. Outcome measures were 24 h change in neutrophils, 72 h change in haemoglobin, and 10-day gait speed regain. Results: Haemoglobin reached the nadir at day 2–3 and partially recovered by day 10 in all patients, with sarcopenia and undernutrition being the strongest predictors of the postoperative drop (−2.37 g∙dL−1 and −0.80 g∙dL−1, p < 0.05). Neutrophils peaked immediately after surgery and returned to baseline levels at discharge, with sarcopenic undernutrition displaying a blunted response after surgery (−16.20%, p < 0.01). Undernutrition was found to be the most influential preoperative variable on gait speed recovery, but with a marginal effect. None of the patients covered the reference energy and protein needs through diet in the 10 postoperative days. Conclusions: In this cohort, nutritional disorders with reduced body function and reserves (sarcopenia and undernutrition) grounded a greater vulnerability to surgery in terms of early stress response and short-term recovery. This calls for both advanced planning of nutritional prehabilitation strategies for these conditions and adequate postoperative nutritional support.