Integrated assessment of preoperative nutritional, inflammatory, and metabolic biomarkers and early outcomes in geriatric hip fracture surgery: a retrospective matched study

BACKGROUND: Early mortality and postoperative delirium remain major challenges in geriatric patients undergoing surgery for hip fractures. Nutritional status, systemic inflammation, and metabolic dysfunction may influence early postoperative outcomes, yet their combined prognostic value has not been well established. METHODS: This retrospective cohort study included 186 patients aged ≥ 65 years who underwent proximal femoral nailing or arthroplasty for hip fractures. Preoperative prognostic nutritional index, systemic immune-inflammation index, and triglyceride-glucose index were calculated from admission laboratory values. Propensity score matching was used to balance baseline characteristics. The primary outcomes were 30-day mortality and postoperative delirium. RESULTS: After propensity score matching, 70 patient pairs were analyzed. Postoperative delirium was more frequent in the arthroplasty group than in the proximal femoral nailing group (27.1% vs. 14.3%, p = 0.048), while 30-day mortality did not differ significantly between surgical techniques (p = 0.180). Lower prognostic nutritional index and higher systemic immune-inflammation index and triglyceride-glucose index were significantly associated with both 30-day mortality and postoperative delirium (all p < 0.001). In multivariable logistic regression analyses, prognostic nutritional index (OR = 1.18 per unit decrease, p = 0.001), systemic immune-inflammation index (OR = 1.14 per 100-unit increase, p < 0.001), and triglyceride-glucose index (OR = 1.92, p = 0.004) were independently associated with 30-day mortality. CONCLUSION: Preoperative prognostic nutritional index, systemic immune-inflammation index, and triglyceride-glucose index were significantly associated with early mortality and postoperative delirium in geriatric hip fracture patients after adjustment for baseline differences. These readily available biomarkers may contribute to perioperative risk stratification; however, prospective multicenter validation studies are needed before routine clinical application.