Preoperative GNRI Predicts Postoperative Constipation after Fixation of Extracapsular Hip Fractures in Older Adults

Lan Guo; Youwei Tian; Ying Liu; Yanan Fu; Zhanbei Ma; Chong Nan

doi:10.1177/21514593261466327

Preoperative GNRI Predicts Postoperative Constipation after Fixation of Extracapsular Hip Fractures in Older Adults

Geriatr Orthop Surg Rehabil. 2026 Jul 4:17:21514593261466327. doi: 10.1177/21514593261466327. eCollection 2026.

Authors

Lan Guo¹, Youwei Tian¹, Ying Liu¹, Yanan Fu², Zhanbei Ma¹, Chong Nan¹

Affiliations

¹ Department of Orthopedics, Baoding No. 1 Central Hospital, Baoding, Hebei, China.
² Department of Western Pharmacy, Baoding No. 1 Central Hospital, Baoding, Hebei, China.

Abstract

Background: Postoperative constipation (POC) is common in older adults after hip fracture surgery and may be influenced by perioperative care and nutritional status. Serum albumin is an imperfect nutrition marker, whereas the Geriatric Nutritional Risk Index (GNRI) combines albumin with body weight and may better reflect nutritional reserve. The association between preoperative GNRI and POC after fixation of AO/OTA 31-A extracapsular hip fractures remains unclear. We evaluated the association of preoperative GNRI with POC and compared discrimination with other preoperative markers.

Methods: We conducted a single-center retrospective cohort study of patients aged ≥65 years undergoing proximal femoral nail fixation for AO/OTA 31-A extracapsular hip fractures. POC was defined as no spontaneous bowel movement for ≥3 postoperative days or laxative/enema use within 72 hours. Multivariable logistic regression adjusted for age, sex, BMI, diabetes, prior stroke/TIA, Parkinson's disease, time to first mobilization (≥48 h), and total opioid dose (morphine-equivalent dose, MED). Discrimination was assessed using ROC AUC; analyses were complete-case.

Results: Among 230 patients, 152 (66%) developed POC. In the expanded model, higher GNRI was associated with lower odds of POC (adjusted OR 0.86 per 1-unit increase, 95% CI 0.81-0.91; P<0.001). Higher BMI (OR 1.18, 95% CI 1.05-1.33; P=0.005), mobilization ≥48 h (OR 2.43, 95% CI 1.22-4.83; P=0.011), and opioid exposure (OR 1.52, 95% CI 1.24-1.85; P<0.001) were associated with higher odds. Model AUC increased from 0.758 to 0.822 after adding perioperative factors. In single-marker ROC analyses, GNRI showed modest discrimination for POC (AUC 0.724, 95% CI 0.650-0.789), higher than serum albumin (AUC 0.689), BMI (AUC 0.539), and age (AUC 0.545).

Conclusions: POC was common after fixation of AO/OTA 31-A extracapsular hip fractures in older adults. Preoperative GNRI provided prognostic information, and perioperative variables further improved discrimination. GNRI may help identify patients who could benefit from proactive bowel management, opioid-sparing strategies, and early mobilization.

Keywords: GNRI; early mobilization; extracapsular hip fracture; opioid use; postoperative constipation.