Original Article · Open access
Validating Mini Nutritional Assessment-Short Form thresholds for postoperative mortality and complications in geriatric hip fracture patients with compromised nutritional status
Abstract
Objectives: This study aims to establish evidence-based cut-off values of the Mini Nutritional Assessment-Short Form (MNA-SF) for predicting key postoperative outcomes including 60-day mortality, complications, and functional ambulation recovery in a broader cohort of elderly hip fracture patients.
Patients and methods: Between January 2022 and July 2024, a total of 183 elderly hip fracture patients (57 males, 126 females; mean age: 82.7 ± 7.6 years; range, 65 to 101 years) who received surgical treatment were included. The patients encompassed the full spectrum of nutritional status (from well-nourished to malnourished). Logistic regression assessed the associations between preoperative MNA-SF scores (as a continuous variable) and 60-day mortality, complication rates, and gait status. Receiver operating characteristic (ROC) curves were used to identify optimal outcome-predictive cut-off values in the total cohort.
Results: In the overall population, 78 of 183 patients (42.6%) developed postoperative complications, with 94 total complication events documented-34 orthopedic-specific complications (36.2%, including eight surgical site infections, four implant-related complications, and 22 affected limb function-related complications) and 60 systemic complications (63.8%, including 25 pulmonary infections, 26 urinary tract infections, 18 deep venous thromboses, 22 delirium cases, and three pressure sores). Lower MNA-SF scores were significantly correlated with increased risks of 60-day mortality and postoperative complications, but not with gait recovery. The optimal predictive cut-off for mortality was ≤ 7 (adjusted odds ratio [OR] = 0.72, 95% confidence interval [CI] 0.57-0.90; sensitivity 73.7%, specificity 64.0%; area under the curve [AUC] = 0.708). For complications, the optimal cut-off was ≤ 8 (adjusted OR = 0.82, 95% CI 0.72-0.93; sensitivity 74.4%, specificity 51.6%; AUC = 0.645).
Conclusion: The MNA-SF is a valuable tool for preoperative risk stratification in geriatric hip fracture patients. We propose novel, evidence-based cut-off values (≤ 7 for mortality and ≤ 8 for complications) derived from a comprehensive cohort, which provide clinically actionable thresholds for identifying high-risk patients most likely to benefit from targeted nutritional and medical interventions.
Declarations
Author Contributions
C.W.: Concept/design; Z.L.: Data collection; L.S.: Analysis/interpretation; Y.M.: Literature review; Y.L.: Writing; C.L.: Critical revision; M.L.: References & funding; Q.Z.: Materials; Y.L.: Supervision; H.Y.: Other contributions. All authors reviewed and approved the final manuscript.
Conflict of Interest
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
Financial Disclosure
Capital's Funds for Health Improvement and Research (Grant No. 2022-2-2073).
Data Sharing Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
AI Disclosure
The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.
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