Association of nutrition status and hospital-acquired infections in older adult orthopedic trauma patients

Background Malnutrition is linked to suboptimal outcomes following elective surgery. Trauma patients do not typically have an opportunity for preoperative nutrition optimization and may be at risk for malnutrition. Our goal was to investigate whether nutrition status is associated with development of hospital-acquired infections (HAIs) in older adult, orthopedic trauma patients. Methods We performed a retrospective analysis of data between January 1, 2017, and August 30, 2018, from the Massachusetts General Hospital Geriatric Inpatient Fracture Trauma Service. Admission nutrition status was assessed using the Mini Nutritional Assessment (MNA) and HAIs were validated through the American College of Surgeons National Surgical Quality Improvement Project database. To investigate whether nutrition status is associated with HAIs, we performed a multivariable logistic regression analysis controlling for age, sex, Charlson Comorbidity Index, glomerular filtration rate, and type of anesthesia. Results Four hundred sixty-one patients comprised the analytic cohort. Multivariable regression analysis demonstrated that each unit increment in MNA score was associated with a 13% reduction in risk of HAI (odds ratio, 0.87; 95% CI, 0.79-0.97). Furthermore, adjusting for timing of perioperative antibiotics, perioperative transfusions, or development of pressure injury during hospitalization did not materially change these results. Conclusion Our results demonstrate that malnutrition is highly prevalent in older adult, orthopedic trauma patients and that nutrition status may influence the risk of developing HAIs in this cohort of patients. Further studies are needed to determine whether optimizing perioperative nutrition in older adult, orthopedic trauma patients can reduce infectious complications and improve overall health outcomes.