Effects of perioperative probiotic supplementation on postoperative gastrointestinal recovery in elderly hip fracture patients: a randomized controlled trial

Abstract

Background: Enhanced Recovery After Surgery (ERAS) protocol aims to accelerate recovery and reduce complications in postoperative patients. Preoperative carbohydrate intake is recommended to reduce insulin resistance but is limited by safety concerns in elderly trauma patients. Probiotics may improve gastrointestinal function and barrier integrity. This study investigates whether perioperative probiotics can be a safe and effective alternative to preoperative oral nutrition in elderly hip fracture patients. Methods: Elderly patients (≥ 65 years) with hip fractures were randomized into three groups: control (fasting), preoperative nutrition (200 mL carbohydrate-rich supplement 2 h before surgery) and perioperative probiotics (Bifidobacterium triple viable capsules twice daily from admission to discharge). The primary outcome was the time to first postoperative flatus. Secondary outcomes included perioperative levels of blood glucose, insulin, C-reactive protein (CRP) and intestinal barrier integrity biomarkers. Mean arterial pressure (MAP), heart rate (HR), postoperative pain score, delirium occurrence and length of hospital stay were also assessed. Results: A total of 170 patients were enrolled and included in the intention-to-treat (ITT) analysis, of whom 154 were included in the per-protocol (PP) analysis for the primary outcome. Baseline characteristics and intraoperative parameters were comparable between groups. Both nutrition and probiotic groups had shorter time to first postoperative flatus than the control group, with the probiotic group showing the fastest recovery and greatest improvement in intestinal barrier markers. No significant differences were observed in postoperative delirium, pain scores or hospital stay between groups. No increase in adverse events related to probiotic or nutritional supplementation was found. Conclusion: Both perioperative probiotics and preoperative nutritional supplementation improved postoperative gastrointestinal recovery in elderly hip fracture patients. Probiotics appeared safe and convenient, and may represent a promising ERAS strategy. Multicenter studies with longer follow-up are needed to confirm these results. Trial registration: The trial was retrospectively registered on 14 September 2024 and the registration number is ChiCTR2400089785.