OTA 2013 Posters

Scientific Poster #19 Geriatric OTA 2013

A Simple Way to Improve Hospital Medical Care for Hip Fracture Patients: Testing Protein Levels

Yael Sagy; Ahuva Weiss-Meilik; Shani Gershtein; Moshe Salai; Ely L. Steinberg, MD;
Department of Orthopaedic Surgery, Tel-Aviv Sourasky Medical Center,
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Background/Purpose: Hip fractures cause significant morbidity and mortality in older people. The orthopaedic POSSUM (physiological and operative severity score for the enumeration of mortality and morbidity) score (OPS) is widely accepted for the evaluation of mortality and morbidity risks in orthopaedic patients, but it does not take malnutrition parameters into account. Low preoperative albumin and protein levels, a marker for malnutrition, could be of major importance in the management of these patients. There are no guidelines in Israel for testing protein levels in patients presenting with hip fractures, nor are these tests routinely performed. The purpose of this study was to compare the impact of protein levels with that of the physiological OPS and its components on the mortality and morbidity risks of patients with hip fractures.

Methods: Files of 2269 consecutive patients undergoing surgery for hip fracture in our medical center between 2008 and 2011 were retrospectively evaluated. OPS parameters were available for 1770 patients. Albumin and total protein levels had been tested in only 387 (17.1%) and 279 (12.3%) patients, respectively. The relative impact of protein levels and the components of the physiological OPS were compared by multivariate logistic regression models for mortality and composite outcome (perihospitalization or perioperative mortality, additional surgery during hospitalization, 7-day hospital readmission, transfer to intensive care, perihospitalization deep vein thrombosis, myocardial infarction, and pulmonary or systemic embolism). The Charlson comorbidity score, provision of intraoperative transfusion, and time from hospital arrival to surgery were also assessed. The area under the curve (AUC) compared the predictive value of the OPS to that of models with and without protein level data for mortality.

Results: Preoperative albumin and total protein levels were inversely associated with mortality in multivariate models (albumin g/L OR [odds ratio] = 0.89, P = 0.009; protein g/L OR = 0.92, P = 0.009) and in composite outcome (protein OR = 0.94, P = 0.014). The AUC for the prediction of mortality by the OPS (n = 1770) was 0.632 (95% CI [confidence interval]: 0.580-0.684, P <0.001), while the AUC for a model including protein levels (n = 279) performed better (AUC = 0.742 [P <0.001, 95% CI: 0.649-0.834]).

Conclusion: Lower preoperative protein and albumin levels are strongly associated with an increased risk for mortality and poor outcomes in patients operated for hip fracture. Protein and albumin levels should be included in the routine laboratory tests for patients presenting with hip fractures. Protein supplementation should be provided when indicated.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.