Perioperative hemodynamic follow-up and results of preoperative aim nutrition and fluid treatment in femoral neck fracture elderly patients

Introduction and Aim: The aim of a balanced nutrition is to maintain the fluid need and the supply of energy and nutritive elements and the rapid healing by optimal fluid intake in an increased metabolic patients' condition. In this way, the gastrointestinal system functions are improved in an early stage by minimizing the negative protein balance to the lowest rate and by protecting muscle, immune and cognitive functions. 30 % of patients who are going to undergo major surgery are affected by malnutrition. With the knowledge of adverse clinical effects of these preoperative nutritional disorders, the opinion of preoperative nutritional support has been hypothesized. With this study, we aimed to observe a potential decrease of the perioperative complications especially in elderly and patients with comorbidity by surveillance of fluid and nutrition support. Material and Method: The patients were divided into two groups, with patients receiving conventional nutrition and fluid treatment by the surgical department (n=23) and patients (n=24) with nutritional and fluid treatment based on individually calculated fluid and calory need. All patients were examined by standardized mini mental test on the day, when included into the study and on the first postoperative day. Again on the first and fifth postoperative day, the triceps skinfold thickness was measured. In the postoperative period, all patients were explored on pain, nausea, vomiting, standardized mini mental test, need of blood and blood products and complications. After completing each patients' routine monitorization, sedation was performed with midazolam under aseptic conditions and spinal anesthesia was done. Results: In the patients group, observed by the anesthesiologists, there was determined a marked, significant difference in the standardized mini mental test and the triceps skinfold thickness in the postoperative period. Further, the postoperative mean hemoglobin and total protein results reveiled a significant statistical difference. The postoperative albumin values were significant in favour of the anestesia followed group. Postoperative there was detected a significant statistical difference between the groups according to the severity of pain, nausea and vomiting. Discussion and Summary In conditions of undernutrition tissue-feeding cannot be maintained and as a result, a limitation and disturbance of cellular and organic processes can be seen. As a consequence of these disorders, the extension of healing process, an increase of postoperative complications and prolongation of hospitalization can lead to a circle of increasing health costs. The improvement of the patients' life quality in the postoperative period can be related to the preoperative nutritional arrangement. We think that a balanced preoperative nutrition contributes to the postoperative period positively with the results of our study supporting our hypothesis. Key Words: Nutrition, Fluid Resuscitation, Geriatrics, Femoral Neck Fracture, Perioperative Complication.