From Frailty to Chronic Pain: Nutritional Status and Pain Trajectories After Hip Fracture in the Elderly

Background Hip fracture in elderly patients represents a major clinical challenge, with recovery influenced not only by surgical factors but also by frailty, nutritional vulnerability, inflammation and postoperative pain trajectories. While acute postoperative pain is well studied, determinants of pain persistence and chronification remain unclear. Objective To investigate associations between nutritional screening tools, selected inflammatory and metabolic biomarkers, and postoperative pain outcomes in elderly patients undergoing hip fracture surgery. Secondary objectives included examining relationships with frailty and postoperative functional independence. Methods Eighty patients aged ≥80 years undergoing surgical repair of femoral neck or intertrochanteric fractures were prospectively enrolled. Preoperative assessments included frailty evaluation, Mini Nutritional Assessment–Short Form (MNA-SF), modified Nutrition Risk in the Critically Ill (mNUTRIC) score, APACHE and SOFA scores, and laboratory biomarkers (albumin, CRP, RDW, LDH, ferritin and calcium). Pain intensity was assessed using the Visual Analog Scale preoperatively, acutely postoperatively, at 30 days and at six months. Functional independence was evaluated after discharge. Associations were analyzed using Spearman’s rank correlation. Results Acute postoperative pain was weakly associated with preoperative pain. Pain at 30 days and six months showed stronger associations with frailty, hypoalbuminemia, inflammatory markers and higher APACHE/SOFA scores. Lower MNA-SF and higher mNUTRIC scores were moderately associated with 30-day pain and strongly associated with chronic pain. Better nutritional status correlated with greater postoperative functional independence. Conclusion Chronic postsurgical pain in elderly hip fracture patients reflects frailty, nutritional depletion and metabolic stress rather than surgical injury alone. Integrating nutritional screening into perioperative care may improve recovery.