The goal of this observational study is to learn whether preoperative oral nutrition support improves clinical outcomes in elderly patients with femur fractures who have a high frailty index. The main questions it aims to answer are:

• Does preoperative nutrition support improve hemodynamic stability during and after surgery?
• Does it reduce postoperative complications, mortality, and length of hospital stay?

Researchers will compare patients who receive preoperative oral nutrition support with those who follow routine nutrition.

Participants will:

• Receive routine medical care with or without nutrition support
• Have their hemodynamic values, complications, and outcomes recorded during hospitalization
• Be followed at 30 and 90 days after surgery for complications and mortality.

Femur fractures in elderly patients with a high frailty index are associated with increased perioperative morbidity and mortality. Malnutrition is common in this population and may worsen hemodynamic instability, delay recovery, and increase postoperative complications. Although nutritional support has been studied in geriatric patients, data specific to frail patients with femur fractures are limited.

This prospective observational study will be conducted at the Düzce University Faculty of Medicine, Department of Anesthesiology and Reanimation, between January 2026 and December 2027. Patients aged 65 years or older with femur fractures and a Clinical Frailty Scale score ≥5 who are scheduled for surgery and expected to require postoperative intensive care will be included. Nutritional status will be assessed using NRS-2002 and Food Quality Score Index questionnaires.

Participants will be observed in two groups according to routine clinical practice: patients receiving preoperative oral nutritional support recommended by the nutrition clinic, and patients continuing their usual diet without additional support. No intervention will be assigned by the investigators.

Hemodynamic parameters will be recorded intraoperatively and during postoperative intensive care and ward follow-up. Anthropometric measurements (arm and waist circumference), laboratory values, morbidity, mortality, ICU length of stay, and total hospital stay will be documented. Patients will also be evaluated at postoperative 30 and 90 days for complications and survival.

The study aims to determine whether preoperative nutritional support is associated with improved hemodynamic stability and reduced morbidity and mortality in frail elderly patients with femur fractures. The results may guide perioperative nutritional strategies in high-risk geriatric surgical populations.

Inclusion Criteria:

• Patients aged 65 years or older hospitalized with a diagnosis of femur fracture
• High frailty index (Clinical Frailty Scale ≥ 5)
• Patients expected to require postoperative intensive care

Exclusion Criteria:

• Patients requiring preoperative intensive care
• Patients unable to tolerate enteral nutrition
• Patients with advanced liver or kidney failure
• Patients unable to cooperate
• Patients with neuromuscular disease
• Patients with severe malnutrition according to NRS-2002 guidelines
• Patients who refuse to participate

The study population consists of elderly patients aged 65 years or older with femur fractures and a high frailty index (Clinical Frailty Scale ≥5) who are admitted for surgery at Düzce University Faculty of Medicine Hospital and are expected to require postoperative intensive care. Patients receiving preoperative oral nutritional support as part of routine clinical practice and those continuing their usual diet will be observed and followed perioperatively and postoperatively.