The Utility of Baseline Prognostic Nutritional Index (PNI) and Functional Status Among Hip Fracture and Distal Femur Fracture Patients

BACKGROUND : Baseline and functional and nutritional status are intertwined and associated with perioperative complications and mortality following orthopedic surgery, especially among geriatric patients. The prognostic nutrition index (PNI) is commonly used to appraise nutrition status. In many acute traumatic settings, the components of PNI can often be acutely influenced. Therefore, the aim of this of this study is to evaluate baseline functional status and PNI relationship with prolonged length of stay and 30-day mortality among geriatric distal femur and hip fracture patients. METHODS : Patients ≥ 65 years with closed isolated Hip fracture and distal femur fractures (DFF) treated between 2005 and 2021 were identified by the National Surgical Quality Improvement Program (NSQIP) database. The primary outcome was comparison of prolonged length of stay and 30-day mortality across reported baseline PNI categories (< 35, 35-38, > 38) and functional status (fully dependent, partially dependent, totally independent). Univariable and multivariable Logistic regression analyses identified independent risk factors for each defined outcome. RESULTS : A total of 81,543 geriatric DFF and hip fracture patients were identified. The mean age was 79.5 (IQR: 74-85). Those with independent functional status reported a greater mean PNI of 35.7 compared to patients with partially (34.4) and fully (33.9) dependent status (p38 when compared to those with a PNI