Validating Mini Nutritional Assessment-Short Form thresholds for postoperative mortality and complications in...

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.

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.

In the overall population, 78 of 183 (42.6%) patients 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).

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.