Nutritional optimization for older adults undergoing hip fracture surgery: a randomized controlled pilot trial

Objectives: To identify the incidence of malnutrition in elderly patients with hip fracture, evaluate the impact of a nutritional intervention, and assess feasibility of study design. Design: Randomized controlled pilot trial. Setting: Level 1 trauma center. Patients/Participants: Forty patients ≥65 years undergoing hip fracture surgery were randomized 1:1 to receive standard care or nutritional intervention. Intervention: Standard perioperative care versus comprehensive nutritional intervention. Main Outcome Measurements: Study feasibility, using the RE-AIM framework, was the primary outcome. Tracked metrics included recruitment and retention rate, loss-to-follow-up (LTFU), and medication/laboratory compliance. The clinical outcomes measured were reoperation, readmissions, mortality, grip strength, health-related quality of life, and medical complications. Results: Recruitment rate (64%), improving after implementation of surgeon enrollment and inclusion of dementia patients. Retention rate was 60%, with LTFU primarily because of visit frequency and transportation barriers. Medication and laboratory compliance were poor. All patients had ≥1 deficient nutritional serum marker at baseline. One reoperation occurred in each group. Readmissions were higher in the standard care group (n = 3) versus intervention group (n = 2). One death occurred in the intervention group and 3 in the standard care group. Grip strength increased 2.6 pounds in the intervention group. Conclusions: Nutritional deficiencies are prevalent among patients with geriatric hip fracture. Study feasibility was demonstrated, but LTFU exceeding 20% necessitates targeted enrollment and retention strategies. This study informs a subsequent larger, multicenter randomized controlled trial and provides critical insights into optimal study design and execution. Level of Evidence: Level II; pilot randomized controlled trial.