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Effi cacy of enteral nutritional support after hospital discharge in major gastrointestinal surgery patients: a systematic review ResumenIntroducción: el soporte nutricional en pacientes desnutridos sometidos a cirugía gastrointestinal reduce la tasa de complicaciones y acorta la duración de la estancia. En esta revisión sistemática se analiza su efi cacia después del alta hospitalaria. Métodos: la estrategia de búsqueda (nutrition OR "enteral nutrition" OR "nutritional supplements" OR "oral nutritional supplements" OR "sip feed" OR "sip feeding" OR "dietary counseling") AND ("patient discharge" OR discharge OR postdischarge) AND (surgery OR operation OR "surgical procedure") se introdujo en las bases Medline, CENTRAL y TripDatabase. Fueron criterios de inclusión: tipo de estudio (RCT), idioma (inglés, español) y población del estudio (pacientes sometidos a cirugía gastrointestinal). El riesgo de sesgo se evaluó mediante la metodología Cochrane. Resultados: se incluyeron cinco estudios (446 pacientes), publicados en seis artículos diferentes. Se detectó un alto riesgo de sesgo en la mayoría de ellos. El soporte nutricional mejoró la ingesta de energía y el consumo de proteínas cuando se proporcionaron suplementos orales hiperproteicos. La intervención se asoció con un mejor pronóstico de peso, pero los datos sobre la composición corporal fueron inconsistentes. En la mayoría de los estudios, la intervención nutricional no mejoró la capacidad funcional o la calidad de vida. Ninguno de los estudios analizó los efectos sobre las complicaciones después del alta. Conclusión: el soporte nutricional proporcionado después del alta puede aumentar la ingesta y mejorar el peso corporal, pero la baja calidad de los estudios debilita la validez de los resultados. AbstractIntroduction: Nutritional support for malnourished patients undergoing gastrointestinal surgery reduces the complication rate and shortens the length of stay. The effi cacy of nutritional support after hospital discharge was analyzed in this systematic review. Methods: The search strategy (nutrition OR "enteral nutrition" OR "nutritional supplements" OR "oral nutritional supplements" OR "sip feed" OR "sip feeding" OR "dietary counseling") AND ("patient discharge" OR discharge OR postdischarge) AND (surgery OR operation OR "surgical procedure") was followed in Medline, CENTRAL, and Trip databases. Inclusion criteria comprised: type of study (randomized controlled trial), language (English, Spanish), and subjects (patients undergoing gastrointestinal surgery). The risk of bias was assessed by using the Cochrane methodology. Results: Five studies which were published in six different articles and recruited 446 patients were included. A high risk of bias was detected for most of them. Nutritional support improved energy intake and protein intake when high-protein oral supplements were provided. The intervention was associated with better weight prognosis, but the data about body composition were inconsistent. In most of the trials, nutritional intervention did n...

Llamazares JL. Impacto de una adecuada codificación de la desnutrición relacionada con la enfermedad en los índices hospitalarios. Nutr Hosp 2016;33:86-90 AbstractIntroduction: Disease related malnutrition (DRM) affects at least one in four inpatients, increasing both morbidity and mortality during admission and after discharge. Nevertheless, its repercussion on hospital activity is not properly quantified. Objective: To determine the impact of an adequate coding of DRM and procedures employed to reverse it in the hospital average weight and other hospital indicators. Methods: Comparative study carried out in every patients requiring nutritional support and followed up by the Clinical Nutrition and Dietetics Unit of the Endocrinology and Nutrition Department in Complejo Asistencial Universitario de León (Spain) in 2008 and 2013. A nutritional coding report at discharge including diagnosis, nutritional treatment and access was performed following ICD-9-MC.Average weight, average length of stay adjusted by case-mix and case-mix index were compared before and after coding. Results: Hospital average weight increased after coding, both in 2008 (+4.1%) and 2013 (+1.7%) and especially in those departments in which nutritional screening is performed (Hematology, +10.5%). Average length of stay adjusted by case-mix was reduced under 1 (-5.7% and -0.2% in 2008 y 2013), pointing out to better functioning, and functioning index also decreased (-5.6% y -0.4% in 2008 and 2013), what means a higher efficiency. Conclusion: Adequate coding of nutritional diagnosis and treatment of patients with DRM increases the average weight of our hospital and improves average length of stay adjusted by case-mix and functioning index.

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