Validating Mini Nutritional Assessment-Short Form thresholds for postoperative mortality and complications in geriatric hip fracture patients with compromised nutritional status
Yan Liu1
, Lili Sun2, Zhiwei Liu2, Yannan Ma3, Chen Li3, Menglin Liang3, Qing Zhang3, Han Yu3, Cong Wang3
1Department of Emergency, Peking University International Hospital, Beijing, China
2Department of Emergency, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
3Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Keywords: Complications, cut-off value, gait status, hip fracture, Mini Nutritional Assessment-Short Form, mortality.
Abstract
Objectives: This study aims to establish evidence-based cut-off values of the Mini Nutritional Assessment-Short Form (MNA-SF) for predicting key postoperative outcomes including 60-day mortality, complications, and functional ambulation recovery in a broader cohort of elderly hip fracture patients.
Patients and methods: Between January 2022 and July 2024, a total of 183 elderly hip fracture patients (57 males, 126 females; mean age: 82.7 ± 7.6 years; range, 65 to 101 years) who received surgical treatment were included. The patients encompassed the full spectrum of nutritional status (from well-nourished to malnourished). Logistic regression assessed the associations between preoperative MNA-SF scores (as a continuous variable) and 60-day mortality, complication rates, and gait status. Receiver operating characteristic (ROC) curves were used to identify optimal outcome-predictive cut-off values in the total cohort.
Results: In the overall population, 78 of 183 patients (42.6%) developed postoperative complications, with 94 total complication events documented-34 orthopedic-specific complications (36.2%, including eight surgical site infections, four implant-related complications, and 22 affected limb function-related complications) and 60 systemic complications (63.8%, including 25 pulmonary infections, 26 urinary tract infections, 18 deep venous thromboses, 22 delirium cases, and three pressure sores). Lower MNA-SF scores were significantly correlated with increased risks of 60-day mortality and postoperative complications, but not with gait recovery. The optimal predictive cut-off for mortality was ≤ 7 (adjusted odds ratio [OR] = 0.72, 95% confidence interval [CI]: 0.57–0.90; sensitivity 73.7%, specificity 64.0%; area under the curve [AUC] = 0.708). For complications, the optimal cut-off was ≤ 8 (adjusted OR = 0.82, 95% CI: 0.72–0.93; sensitivity 74.4%, specificity 51.6%; AUC = 0.645).
Conclusion: The MNA-SF is a valuable tool for preoperative risk stratification in geriatric hip fracture patients. We propose novel, evidence-based cut-off values (≤ 7 for mortality and ≤ 8 for complications) derived from a comprehensive cohort, which provide clinically actionable thresholds for identifying high-risk patients most likely to benefit from targeted nutritional and medical interventions.
Citation: Liu Y, Sun L, Liu Z, Ma Y, Li C, Liang M, et al. Validating Mini Nutritional Assessment-Short Form thresholds for postoperative mortality and complications in geriatric hip fracture patients with compromised nutritional status. Jt Dis Relat Surg 2026;37(x):i-ix. doi: 10.52312/jdrs.2026.2417.