Preoperative nutritional risk and 24-h additional opioid consumption in older adults undergoing hip fracture surgery: a retrospective cohort study
Year: 2026
Type: article
Abstract: Background Nutritional risk is common in older adults with hip fracture, but its association with postoperative analgesic requirements remains unclear. We examined the association between preoperative nutritional risk and 24-h additional opioid consumption. We also explored whether this association varied by peripheral nerve block use. Methods This retrospective cohort included 617 adults aged ≥65 years who underwent hip fracture surgery between 2021 and 2025. Nutritional risk was defined as a Nutritional Risk Screening 2002 (NRS-2002) score ≥3. The primary outcome was additional opioid consumption during the first 24 h after postoperative PCIA initiation, including delivered demand boluses and systemic rescue opioids but excluding programmed basal infusion. Opioid doses were converted to intravenous morphine equivalents (IVME). Tweedie generalized linear models with a log link were used to estimate mean ratios (MRs). Models were adjusted for patient, surgical, and anesthetic factors. We also assessed the interaction with peripheral nerve block and performed sensitivity analyses. Results Of 617 patients, 257 (41.7%) had nutritional risk. Median 24-h additional opioid consumption was 5.95 mg IVME (interquartile range, 3.00–8.99) in patients with nutritional risk and 4.39 mg (2.13–6.88) in those without. Nutritional risk was associated with higher mean additional opioid consumption in the fully adjusted model (MR 1.23, 95% CI, 1.11–1.38; p < 0.001). Peripheral nerve block was associated with lower mean additional opioid consumption (MR 0.72, 95% CI, 0.65–0.80; p < 0.001). The interaction between nutritional risk and nerve block was not significant ( p = 0.849). Findings remained consistent across sensitivity analyses. Conclusion Preoperative nutritional risk was associated with higher mean additional opioid consumption after hip fracture surgery. The clinical value of using nutritional-risk information in postoperative analgesic care requires prospective evaluation.
Source: Frontiers in Nutrition
Institution: First Affiliated Hospital of Zhengzhou University
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7225830723