Background: Hip fractures in the elderly are associated with profound morbidity, mortality, and prolonged hospital stays. Malnutrition is highly prevalent in this vulnerable demographic and significantly exacerbates postoperative complications, including infections and delirium. While enhanced recovery after surgery protocols emphasize postoperative nutrition, the impact of preoperative nutritional optimization remains underexplored.

Objective: This study aimed to evaluate the efficacy of a brief, standardized preoperative nutritional optimization protocol on postoperative recovery metrics in elderly patients undergoing hip fracture surgery.

Method: A simulated retrospective cohort study was conducted using synthesized academic training data comprising 320 elderly patients (aged 65 years and older) who underwent surgical repair for a low-energy hip fracture. The intervention group (n=160) received a high-protein, energy-dense oral nutritional supplement for at least 48 hours prior to surgery, while the control group (n=160) received standard preoperative care. The primary outcomes were the incidence of overall postoperative complications and the length of hospital stay.

Results: The nutritional optimization group demonstrated a significantly lower incidence of overall postoperative complications compared to the control group (18.8% versus 31.3%, p=0.012). The mean length of hospital stay was significantly shorter in the intervention group (8.2 days versus 10.5 days, p<0.001). Additionally, the incidence of postoperative delirium was significantly reduced in the nutrition group (10.0% versus 21.3%, p=0.006).