Nightly enteral nutrition support of elderly hip fracture patients: A phase I trial

Objective: This non-blinded randomized controlled trial was the first phase of a planned series of investigations designed to test the efficacy of aggressive post-operative enteral nutrition support to decrease the rate of post-operative complications or improve long-term outcomes in specifically defined subgroups of elderly patients who have sustained a hip fracture requiring surgery. Methods: Eighteen patients (17 males) were randomized to the treatment (eight male subjects) or control groups. The control group (mean age 76.5 +/- 6.1 years) received standard post-operative care. Subjects in the treatment group (mean age 74.5 +/- 2.1 years) received 125 cc/hour of nasoenteral tube feedings over ii hours each night in addition to standard post-operative nutritional care. Results: Both the treatment and control groups had reduced volitional nutrient intakes for the first 7 post-operative days (3,966 +/- 2,238 vs. 4,263 +/- 2,916 kJ/day [948 +/- 535 vs. 1019 +/- 697 kcal/day], p = 0.815), but the treatment subjects had a greater total nutrient intake (7,719 +/- 2,109 vs. 4,301 +/- 2,858 kJ/day [1845 +/- 504 vs. 1028 +/- 683 kcal], p = 0.012). On average, treatment subjects were tube fed for 15.8 +/- 16.4 days. There was no difference between the groups (treatment vs. controls) in the rate of post-operative life-threatening complications (25 vs. 30%, p = 1.00) or in-hospital mortality (0 vs. 30%, p = 0.216). Mortality within 6 months subsequent to surgery was lower in the treatment group compared to the controls (0 vs. 50%, p = 0.036). Discussion: We conclude that nightly enteral feedings are a safe and effective means of supplementing nutrient intake. The greatest impact of nutrition support may be to reduce mortality.