It has been reported that malnutrition is one of the most likely factors related to hip fracture patients prolonged stay in hospital. For any person who has experienced a stay in hospital, having to stay longer than expected is not welcome prospect; who doesn’t want to be in the comfort of their own home when they feel unwell.
Currently, patients are given nutritional supplements after surgery to combat and treat malnutrition but this treatment may be insufficient as their body experiences a metabolic stress response following the fracture and subsequent surgery. This stress response includes a rapid onset of Insulin resistance, which effects include muscle breakdown and decreased muscle strength. This is not the optimal outcome for already frail and weakened patients.
To combat this there a trend to use a new and more patient friendly recommendation, within the Enhanced Recovery After Surgery protocol (ERAS protocol), being used prior to surgery. Rather than requiring patients to not eat anything for 6 hours prior to surgery there is a recommendation to allow patients to be given a carbohydrate supplement drink. It is hoped that this carbohydrate supplement will help to prevent insulin resistance by switching off the fasting state in the body, as would eating a meal yet it is safe to consume prior to surgery as it is a clear fluid.
While there is great evidence for the effectiveness of the ERAS protocol in elective surgery the effect of the individual component(s) helping to reach these findings remains unclear - we don’t know which part of this protocol as a whole is helping these patients.
Emergency surgery, such as that performed for hip fractures, carries a mortality rate at least ten times higher than many similar elective procedures. So, Dr Jack Bell knows it is important to understand the effect the ERAS protocol and each of its individual elements have in order to reach better outcomes for patients.
The Prince Charles Hospital, Hip Fracture Unit presents the ideal environment to conduct a trial to investigate the effects and potential benefits of the pre-operative carbohydrate supplement drink. Findings from this study could be clinically applied and enhance patient outcomes across the globe; helping to get hip fracture patients to recover and ensure they get home sooner rather than later.