The CONUT Score Independently Predicts Mortality in Older Patients with Hip Fracture

Background and Objectives: Malnutrition is highly prevalent among older adults with hip fracture and is associated with poorer surgical outcomes, yet its prognostic relevance is often under-recognized in routine orthopaedic practice. The Controlling Nutritional Status (CONUT) score is an objective laboratory-based screening tool; however, evidence regarding its value for predicting long-term mortality after hip fracture remains limited. This study aimed to evaluate whether nutritional status assessed by the CONUT score independently predicts mortality in older patients with hip fracture. Materials and Methods: This retrospective observational cohort study included consecutive patients aged ≥70 years admitted for hip fracture to a tertiary hospital between 2014 and 2021. Nutritional status was assessed at admission using the CONUT score and categorized as no, mild, moderate, or severe nutritional risk. Demographic characteristics, comorbidity burden, perioperative variables, postoperative morbidity, and mortality up to five years were recorded. Survival was evaluated using Kaplan-Meier methods, and independent predictors of mortality were identified using multivariable Cox proportional hazards models adjusted for clinically relevant confounders. Results: A total of 2798 patients were included (mean age [SD] 84.3 [6.3] years; 26.4% male), of whom 79.2% presented some degree of nutritional risk at admission. Mortality increased overall with worsening nutritional status (p < 0.001). After comprehensive multivariable adjustment, higher CONUT scores remained independently associated with mortality, with each one-point increase associated with an approximately 22% higher risk of long-term death. Poorer nutritional status was also associated with higher postoperative complication rates, greater transfusion requirements, and longer hospital stay. Conclusions: Nutritional status assessed using the CONUT score is an independent predictor of short-, mid-, and long-term mortality in older patients undergoing surgery for hip fracture. Incorporation of objective nutritional screening into orthogeriatric pathways may improve perioperative risk stratification and support targeted multidisciplinary management.