Difference in Composite End Point of Readmission and Death Between Malnourished and Nonmalnourished Veterans Assessed Using Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Clinical Characteristics

Abstract

Malnutrition was an independent risk factor for readmission within 30 days or death within 90 days of discharge. Malnourished patients had higher rates of readmission, higher mortality rates, and longer lengths of stay and were more likely to be discharged to nursing homes.

Malnutrition Identified by Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Is Associated With More 30‐Day Readmissions, Greater Hospital Mortality, and Longer Hospital Stays: A Retrospective Analysis of Nutrition Assessment Data in a Major Medical Center

“…In 682 Portuguese hospitalized patients, LOS >7 days was greater in the malnourished group (67% vs 31%, P < .001), an outcome that was associated with approximately 20% greater cost of care . The malnourished VA patients more often had LOS >7 days (41% vs 14%, P < .001) . Our sample also had 3 days longer LOS in survivors (15 vs 12 days), time that would increase the cost of care.…”

“…When criteria similar to AND/ASPEN criteria were used in 1361 emergency surgery patients in a single ICU, mortality was increased in malnourished patients (nonspecific malnutrition vs protein‐energy malnutrition vs no malnutrition, respectively: in‐hospital mortality, 10.8% vs 18.7% vs 6.8%, P = .001; 90‐day mortality, 18.6% vs 31.8% vs 13.1%, P < .001; 12‐month mortality, 29.3% vs 48.6% vs 25.6%, P < .001). 12 In a case–control comparison of 202 malnourished patients with 202 patients of similar age who were admitted to the same service on the same day in a VA hospital, the malnourished patients had greater 90‐day mortality (32% vs 8%) . In our sample of 3907 patients admitted for medical and/or surgical treatments, the in‐hospital mortality was greater in malnourished patients than those without malnutrition (8% vs 5%).…”

“…In patients with gastrointestinal (GI) surgery, readmissions were more frequent in the malnourished (22.6% vs 16.1%, P = .045) . In Veterans Affairs (VA) case–control patients, readmissions were greater in the malnourished group (31% vs 12%) . In surgical ICU patients, 30‐day readmissions were increased in patients with protein‐energy malnutrition (28.5% vs 18.7%, P = .045) .…”

Malnutrition Diagnosis in Critically Ill Patients Using 2012 Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Standardized Diagnostic Characteristics Is Associated With Longer Hospital and Intensive Care Unit Length of Stay and Increased In‐Hospital Mortality

“…Notably, however, this malnutrition diagnosis validation used convenience samples of 38–49 records from each ICU, so we were unable to conduct a power analysis for this sub‐study. Moreover, our study period came several years after the AND/ASPEN criteria were first implemented, which, unlike earlier studies when clinicians were still familiarizing themselves with identifying malnutrition using the new criteria, allowed us to more reliably validate the criteria …”

“…In this study, our primary analyses consider patients coded as E43 as having “severe malnutrition” and patients coded as E44.0, E44.1, or “no diagnosis” as having “no severe malnutrition.” Because the standardized diagnostic characteristics indicate that the difference between mild and moderate malnutrition is clinically indistinguishable, we chose to dichotomize our study populations to those with severe malnutrition and those without severe malnutrition (including those with mild and moderate malnutrition). Prior studies have compared those with severe and those with mild or moderate malnutrition . Therefore, we conducted a secondary analysis dichotomizing malnutrition into “severe and moderate malnutrition” and “mild and no malnutrition” groups to allow for comparability between studies.…”