Development of a Clinical Management Pathway for Perioperative Nutritional Risk in Elderly Patients with Hip Fractures

Weiyu Pan,1,* Yu Xie,1,* Junjuan Zhang,1 Huimin Yang,1 Cheng Cheng,2 Hongmei Zhang3 1Department of Orthopedics, Henan Provincial Intelligent Nursing and Transformation Engineering Research Center, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, 450003, People’s Republic of China; 2Department of Orthopedics, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China; 3Department of Nursing, Henan Provincial Intelligent Nursing and Transformation Engineering Research Center, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, 450003, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hongmei Zhang, Email [email protected] Cheng Cheng, Email [email protected]: The nutritional challenges faced by elderly patients with hip fractures during the perioperative period are significantly associated with clinical outcomes. This study aims to develop a clinical management pathway tailored for elderly hip fracture patients at nutritional risk during the perioperative period, with the objectives of enhancing patient management precision, reducing the duration of hospitalization, and minimizing associated healthcare costs.Methods: Based on the perioperative time sequence, nursing process framework, and the five-step principle of nutritional diagnosis and treatment, literature review, Delphi method, and priority graph method were employed to determine the content and hierarchical weight indicators of the clinical management pathway for this patient population.Results: A total of 20 experts participated in two rounds of Delphi consultation, with effective response rates of 100% in both rounds. The authority coefficients of the experts were 0.890 and 0.923; the coefficient of variation ranged from 0.045 to 0.226 and 0 to 0.247, and the Kendall’s W coefficients were 0.575 and 0.22 (P < 0.001), respectively. The finalized clinical management pathway included 6 primary indicators, 18 secondary indicators, and 103 tertiary indicators.Conclusion: The constructed clinical management pathway for elderly hip fracture patients at nutritional risk during the perioperative period is scientifically sound, comprehensive in content, and highly specialized. It offers a valuable reference for nutritional management and represents a meaningful step toward precise clinical care in this patient population.Keywords: hip fracture, aged, delphi technique, nutrition assessment, critical pathways