GNRI and Rectus Femoris Muscle Thickness in Older Patients Undergoing Hip Fracture Surgery

August 6, 2026 updated by: Oznur Demiroluk, Fatih Sultan Mehmet Training and Research Hospital

Prognostic Value of the Geriatric Nutritional Risk Index and Ultrasonographic Rectus Femoris Muscle Thickness in Older Patients Undergoing Hip Fracture Surgery: A Prospective Observational Study

This prospective observational study will evaluate whether nutritional risk and reduced muscle mass are associated with postoperative outcomes in adults aged 65 years or older undergoing surgery for hip fracture.

Nutritional risk will be assessed using the Geriatric Nutritional Risk Index (GNRI), which is calculated from routine preoperative serum albumin, body weight, and ideal body weight. Rectus femoris muscle thickness will be measured before surgery using a brief, noninvasive ultrasound examination of the non-fractured thigh.

Participants will receive routine clinical care, and no treatment or anesthesia method will be assigned by the study. Clinical information will be collected from hospital records, including postoperative length of hospital stay, surgical site infection, and mortality. Survival status will be evaluated at 30 and 90 days after surgery using hospital records and/or telephone follow-up.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

This is a single-center, prospective observational cohort study involving consecutive patients aged 65 years or older who are scheduled to undergo surgical treatment for hip fracture at Fatih Sultan Mehmet Training and Research Hospital. The study will investigate the prognostic value of the Geriatric Nutritional Risk Index (GNRI) and ultrasonographic rectus femoris muscle thickness (RF-MT) for postoperative clinical outcomes.

After informed consent is obtained, demographic and preoperative clinical data will be recorded, including age, sex, height, weight, body mass index, comorbidities, American Society of Anesthesiologists physical status, fracture type, serum albumin, hemoglobin, C-reactive protein, and creatinine.

The GNRI will be calculated using the following formula:

GNRI = [1.489 × serum albumin (g/L)] + [41.7 × current body weight/ideal body weight].

When the ratio of current body weight to ideal body weight is greater than 1, the ratio will be set to 1. Participants will be classified according to the original GNRI categories: no nutritional risk (GNRI greater than 98), low nutritional risk (GNRI 92 to 98), and moderate or severe nutritional risk (GNRI less than 92).

Rectus femoris muscle thickness will be measured preoperatively on the non-fractured side using a high-frequency linear ultrasound probe. The measurement will be performed with the participant in the supine position at the midpoint between the anterior superior iliac spine and the upper border of the patella. Minimal probe pressure will be applied to avoid muscle compression. After the rectus femoris muscle is visualized in the transverse plane, muscle thickness will be measured as the greatest vertical distance between the superficial and deep fascia. Three measurements will be obtained, and their mean value will be used for analysis. All measurements will be performed by the same investigator experienced in ultrasonography.

Perioperative and postoperative data will include surgical procedure, anesthesia technique, duration of surgery, estimated blood loss, blood transfusion, intensive care unit admission, postoperative hospital length of stay, surgical site infection, and all-cause mortality at 30 and 90 days.

Postoperative hospital length of stay will be calculated as the number of days between surgery and hospital discharge. Prolonged postoperative hospital stay will be defined as a stay exceeding the 75th percentile of postoperative length of stay in the completed study cohort. Surgical site infections will be evaluated according to the Centers for Disease Control and Prevention criteria. Mortality status will be determined from hospital records and/or telephone follow-up.

No study-specific medication, anesthesia technique, surgical treatment, or additional blood sampling will be administered. The only study-specific procedure will be the noninvasive preoperative ultrasound measurement. Associations between GNRI, RF-MT, and postoperative outcomes will be evaluated using multivariable regression and receiver operating characteristic curve analyses.

Study Type

Observational

Enrollment (Estimated)

120

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Turkey (Türkiye)
      • Istanbul, Turkey (Türkiye), 34000
        • University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

The study population will consist of consecutive patients aged 65 years or older who are admitted to Fatih Sultan Mehmet Training and Research Hospital with a hip fracture and are scheduled to undergo surgical treatment. Eligible participants of both sexes will be enrolled after informed consent is obtained. Participants will receive routine perioperative clinical care without any treatment allocation by the study.

Description

Inclusion Criteria:

  • Age 65 years or older
  • Scheduled to undergo surgical treatment for hip fracture
  • Provision of informed consent by the participant or, when applicable, a legally authorized representative

Exclusion Criteria:

  • Pathological fracture or fracture related to malignancy
  • Advanced neuromuscular disease
  • Active infection
  • Planned revision surgery
  • Lower limb amputation or severe deformity preventing rectus femoris muscle thickness measurement
  • Inability to obtain informed consent from the participant or a legally authorized representative

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Geriatric Hip Fracture Cohort
Patients aged 65 years or older undergoing surgical treatment for hip fracture. Preoperative nutritional risk will be assessed using the Geriatric Nutritional Risk Index, and rectus femoris muscle thickness will be measured by ultrasound on the non-fractured side. Participants will receive routine clinical care, and no treatment, anesthesia technique, or surgical intervention will be assigned by the study.
Other: Geriatric Nutritional Risk Index Assessment
Preoperative nutritional risk will be assessed using the Geriatric Nutritional Risk Index (GNRI), calculated from routine serum albumin, current body weight, and ideal body weight. Participants will be categorized as having no nutritional risk (GNRI greater than 98), low nutritional risk (GNRI 92 to 98), or moderate/severe nutritional risk (GNRI less than 92). The assessment will not alter routine clinical care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Participants With Prolonged Postoperative Hospital Stay
Time Frame: From the date of surgery through discharge from the index hospitalization, assessed up to 30 days after surgery.
Postoperative hospital length of stay will be calculated as the number of days from the date of surgery to the date of discharge. Prolonged postoperative hospital stay will be defined as a length of stay exceeding the 75th percentile of the postoperative length-of-stay distribution in the completed study cohort. The outcome will be reported as the number and percentage of participants meeting this criterion.
From the date of surgery through discharge from the index hospitalization, assessed up to 30 days after surgery.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Participants With Surgical Site Infection
Time Frame: From the date of surgery through 90 days after surgery
Surgical site infection will be assessed according to the Centers for Disease Control and Prevention criteria. Superficial and deep incisional infections will be identified using clinical findings, microbiological culture results, radiological findings, and/or a clinical diagnosis made by an infectious diseases or orthopedic specialist. The outcome will be reported as the number and percentage of participants with a surgical site infection.
From the date of surgery through 90 days after surgery
Number of Participants With 30-Day All-Cause Mortality
Time Frame: within 30 days after surgery
Vital status will be determined using hospital records and/or telephone follow-up. The outcome will be reported as the number and percentage of participants who die from any cause within 30 days after surgery.
within 30 days after surgery
Number of Participants With 90-Day All-Cause Mortality
Time Frame: Within 90 days after surgery
Vital status will be determined using hospital records and/or telephone follow-up. The outcome will be reported as the number and percentage of participants who die from any cause within 90 days after surgery.
Within 90 days after surgery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Fatih Sultan Mehmet Training and Research Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

August 1, 2026

Primary Completion (Estimated)

May 1, 2027

Study Completion (Estimated)

June 1, 2027

Study Registration Dates

First Submitted

August 3, 2026

First Submitted That Met QC Criteria

August 6, 2026

First Posted (Actual)

August 7, 2026

Study Record Updates

Last Update Posted (Actual)

August 7, 2026

Last Update Submitted That Met QC Criteria

August 6, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • FSMTRH-GNRI
  • 2026/07-41 (Other Identifier: University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital Scientific Research Ethics Committee)

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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