Dataset Information

Association of preoperative nutritional status evaluated by the controlling nutritional status (CONUT) score with walking independence at 180 days postoperatively: a prospective cohort study in Chinese older patients with hip fracture.

ABSTRACT:

Background

Malnutrition is significantly associated with unfavourable outcomes, but there is little high-level evidence to elucidate the association of malnutrition with losing walking independence (LWI) after hip fracture surgery. This study aimed to assess the association between preoperative nutritional status evaluated by the Controlling Nutritional Status (CONUT) score and walking independence at 180 days postoperatively in Chinese older hip fracture patients.

Methods

This prospective cohort study included 1958 eligible cases from the SSIOS database. The restricted cubic spline (RCS) was used to assess the dose-effect relationship between the CONUT score and recovery of walking independence. Propensity score matching (PSM) was performed to balance potential preoperative confounders, and multivariate logistic regression analysis was applied to assess the association between malnutrition and LWI with perioperative factors for further adjustment. Furthermore, inverse probability treatment weighting (IPTW) and sensitivity analyses were performed to test robustness of the results and the Fine and Grey hazard model was applied to adjust the competing risk of death. Subgroup analyses were used to determine potential population heterogeneity.

Results

We found a negative relationship between the preoperative CONUT score and recovery of walking independence at 180 days postoperatively, and that moderate-to-severe malnutrition evaluated by the CONUT score was independently associated with a 1.42-fold (95%CI, 1.12-1.80; P=0.004) increased risk of LWI. The results were overall robust. And in the Fine and Grey hazard model, the result was still statistically significant despite the apparent decrease in the risk estimate from 1.42 to 1.21. Furthermore, significant heterogeneities were observed in the subgroups of age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, Charlson's comorbidity index (CCI) and surgical delay (P for interaction < 0.05).

Conclusion

Preoperative malnutrition is a significant risk factor for LWI after hip fracture surgery, and nutrition screening on admission would generate potential health benefits.

SUBMITTER: Cheng X

PROVIDER: S-EPMC10498878 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Association of preoperative nutritional status evaluated by the controlling nutritional status score with walking independence at 180 days postoperatively: a prospective cohort study in Chinese older patients with hip fracture.

Cheng Xinqun X Chen Wei W Yan Jincheng J Yang Zhenbang Z Li Chengsi C Wu Dongwei D Wang Tianyu T Zhang Yingze Y Zhu Yanbin Y

International journal of surgery (London, England) 20230901 9

<h4>Background</h4>Malnutrition is significantly associated with unfavorable outcomes, but there is little high-level evidence to elucidate the association of malnutrition with losing walking independence (LWI) after hip fracture surgery. This study aimed to assess the association between preoperative nutritional status evaluated by the Controlling Nutritional Status (CONUT) score and walking independence at 180 days postoperatively in Chinese older hip fracture patients.<h4>Methods</h4>This pro ...[more]

PMID: 37226868

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Project description:The nutritional status of a patient has prognostic potency concerning short- and long-term outcomes, including survival, in many diseases. The controlling nutritional status (CONUT) score is a method for assessing nutritional status and predicting outcomes of several diseases. This study sought to systematically identify the prognostic role of preoperative CONUT score on posttreatment overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) in patients with cancer. The PubMed, SCOPUS, and Google Scholar databases and Google were searched for all dates until December 2019. Original articles investigating the association of preoperative CONUT score with survival in cancer patients who underwent surgery were included. Duplicate and irrelevant reports were screened out and the remaining articles assessed for quality and data extracted during critical analysis. Results of multivariate analysis were used to evaluate the prognostic competence of CONUT score in predicting survival. The search method identified an initial 181 articles, of which 32 were included in the final analysis. Lower OS, CSS, and RFS rates were reported by 100%, 100%, and 87.0% of the included studies, respectively, in cancer patients with high CONUT scores. A prognostic role of the CONUT score for prediction of OS, CSS, and RFS in cancer patients was shown by 91.7%, 90.9%, and 52.6% of the studies, respectively. The receiver operating characteristic curve area under the curve (AUC) value of the CONUT score for predicting OS, CSS, and RFS was at an acceptable level (>0.5) in all studies with available AUC values (n = 19). Sixty percent (12 of 20) of the studies reported that high CONUT score was significantly related to lower BMI. The findings promote confidence that a high preoperative CONUT score is associated with poor survival rate and is an independent prognostic factor of OS and CSS in patients with various types of cancer. Evaluation of the preoperative CONUT score might help clinicians in decision-making with respect to surgical implications.