Early oral nutritional supplementation and postoperative recovery after hip arthroplasty in malnourished older adults with femoral neck fracture
Background Older patients with malnutrition who undergo hip arthroplasty for femoral neck fracture are at high risk of delayed postoperative recovery. This retrospective study aimed to examine the association of early oral nutritional supplementation (ONS) with postoperative nutrition-related laboratory indicators, recovery outcomes, and in-hospital complications in this population. Methods We retrospectively analyzed consecutive patients aged 60 years or older with malnutrition who underwent hemiarthroplasty or total hip arthroplasty for femoral neck fracture between January 2022 and December 2025. Patients were classified into an early ONS group if structured ONS was initiated within 24 h after surgery and into a control group otherwise. Primary outcomes included postoperative changes in serum albumin, prealbumin, hemoglobin, total protein, lymphocyte count, length of hospital stay, time to first ambulation, and time to first flatus. Secondary outcomes were postoperative complications during the index hospitalization. Results Among 294 included patients, 118 received early ONS and 176 served as controls. At discharge, the early ONS group showed more favorable laboratory profiles, including higher serum albumin [β = 1.42, 95% confidence interval (CI): 0.66 to 2.18; p < 0.001], prealbumin (β = 13.58, 95% CI: 5.92 to 21.24; p < 0.001), total protein (β = 1.76, 95% CI: 0.54 to 2.98; p = 0.005), and lymphocyte count (β = 0.11, 95% CI: 0.04 to 0.18; p = 0.002). Early ONS was also associated with shorter time to first ambulation (β = −5.38 h, 95% CI: −7.56 to −3.20; p < 0.001), shorter time to first flatus (β = −6.84 h, 95% CI: −9.53 to −4.15; p < 0.001), and shorter hospital stay (β = −1.29 days, 95% CI: −1.98 to −0.60; p < 0.001). Lower odds of pulmonary infection were observed (odds ratio = 0.46, 95% CI: 0.16 to 0.93; p = 0.041), although this finding should be interpreted cautiously because of the limited number of events. Conclusion Early ONS after hip arthroplasty in older patients with malnutrition and femoral neck fracture was associated with more favorable short-term nutrition-related laboratory profiles and faster postoperative recovery. The association with pulmonary infection warrants cautious interpretation and further validation in prospective studies.