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

Objective: To investigate whether postoperative voluntary energy intake (EI) affects functional recovery with hip fracture during the acute phase.

Design: Prospective cohort study.

Setting: Three acute care hospitals.

Participants: Hip fracture patients (N=200) who were consecutively admitted to 3 acute hospitals because of falling.

Interventions: Not applicable.

Main outcome measures: Patients 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.

Results: The 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).

Conclusions: Postoperative EI that is less than 70% of TEE diminishes functional recovery with hip fracture.