Perioperative nutrition consult and its effect on postoperative delirium and surgical site infection rates in elderly patients undergoing hip fracture fixation

Hip fractures are among the most common conditions affecting the elderly, with global incidence projected to exceed 4.5 million annually by 2050. Frailty and malnutrition are prevalent in this population and increases the risk of postoperative complications, including infection and delirium. This study evaluated the impact of perioperative nutrition consultation on postoperative delirium and surgical site infection (SSI) in elderly patients undergoing hip fracture fixation. A retrospective cohort study using a claims database identified patients aged ≥65 years undergoing hip fracture fixation from 2010-2023. Patients were stratified by receipt of a perioperative nutrition consultation within ±7 days of surgery. A 1:4 propensity-matched cohort was constructed based on demographics and comorbidities. Primary outcomes were postoperative delirium and SSI at 7, 14, 45, and 90 days. Multivariate logistic regression calculated odds ratios with 95% CIs. Patients receiving perioperative nutrition consultation demonstrated significantly lower rates of postoperative delirium at 90 days (3.3% vs 7.2%; OR 0.44; P=0.032). Delirium rates were also lower at 7 days (1.3% vs 2.9%; OR 0.43; P=0.170), 14 days (1.3% vs 3.7%; OR 0.33; P=0.070), and 45 days (2.5% vs 5.5%; OR 0.43; P=0.055), however were not statistically significant. SSI rates were higher in the nutrition consult group at 7 days (4.6% vs 2.3%; OR 2.03; p-value 0.064), 14 days (6.3% vs 3.4%; OR 1.85; p-value 0.059), 45 days (9.6% vs 6.3%; OR 1.55; p-value 0.092), and 90 days (12.6% vs 8.8%; OR 1.47; p-value 0.094), but the results were not statistically significant Perioperative nutrition consultation was associated with lower 90 day postoperative delirium in elderly patients after hip fracture fixation. These findings support the integration of nutritional assessment and intervention into the standard preoperative workflow for geriatric fracture care to improve short-term outcomes and reduce postoperative morbidity.