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Open AccessArticle

Preoperative Ascorbic Acid Levels in Proximal Femur Fracture Patients Have No Postoperative Clinical Impact, While Ascorbic Acid Levels upon Discharge Have a Major Effect on Postoperative Outcome

1
Institute of Nutritional Science, University of Hohenheim, 70599 Stuttgart, Germany
2
Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany
*
Author to whom correspondence should be addressed.
Contributed equally.
J. Clin. Med. 2020, 9(1), 66; https://doi.org/10.3390/jcm9010066
Received: 18 December 2019 / Accepted: 24 December 2019 / Published: 26 December 2019
(This article belongs to the Section Orthopedics)
Proximal femur fractures show a high prevalence in elderly patients and are associated with an elevated risk of multimorbidity and early mortality. Recovery is impaired by malnutrition and oxidative stress, which is affected by antioxidants such as ascorbic acid (AA). This study monitored AA levels during hospitalization of patients with a proximal femur to investigate the influence of AA status to the clinical outcome. AA levels of 25 elderly patients with a proximal femur fracture were measured during hospitalization using high performance liquid chromatography. Plasma samples were collected preoperatively, on the first day after surgery, on the third day after surgery and on the day of discharge. Nutritional Risk Screening 2002 (NRS) and Mini Nutritional Assessment (MNA) were assessed to evaluate the nutritional status. In patients with proximal femoral fractures, preoperative AA concentrations were significantly lower compared to elderly patients without an acute fracture. A significant decrease of 33.8% in AA plasma level was measured on the day after surgery with a significant recovery up to the time of discharge. The preoperative AA status did not have any significant effect on clinical outcome. However, inadequate AA levels (<50 µmol/L) upon discharge significantly increased the incidence and the severity of postoperative complications. These results indicate that the AA status upon discharge has a greater impact on clinical outcome than assumed, and therefore, AA supplementation during hospitalization should be considered. View Full-Text
Keywords: proximal femoral fracture; ascorbic acid; oxidative stress; reactive oxygen species; malnutrition; NRS; MNA; geriatric patients proximal femoral fracture; ascorbic acid; oxidative stress; reactive oxygen species; malnutrition; NRS; MNA; geriatric patients
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Hill-Mündel, K.; Schlegl, J.; Biesalski, H.K.; Ehnert, S.; Schröter, S.; Bahrs, C.; Nohr, D.; Nüssler, A.K.; Ihle, C. Preoperative Ascorbic Acid Levels in Proximal Femur Fracture Patients Have No Postoperative Clinical Impact, While Ascorbic Acid Levels upon Discharge Have a Major Effect on Postoperative Outcome. J. Clin. Med. 2020, 9, 66.

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