Impact of malnutrition on gastrointestinal surgical patients

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

“…Our findings of increased 30‐day readmissions in malnourished patients generally agree with others. 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%) .…”

“…Smaller samples using the AND/ASPEN criteria agree with our finding that in‐hospital mortality is increased in malnourished patients, and report even higher mortality rates after the hospital discharge. In 490 patients who had GI surgery, malnutrition was associated with higher in‐hospital mortality (7.5% vs 2.3%, P < .021) . 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).…”

“…However, only patients who were referred for nutrition assessment were evaluated, and others not referred may also have been malnourished. Although there is no adequate measure of clinical acuity in a general hospital population, the CCI that was applied here, has been validated in other populations, and also applied to hospitalized patients with malnutrition …”

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

“…Among critically ill patients assessed by the AND/ASPEN criteria in the intensive care unit (ICU) (n = 327), Ceniccola et al showed that patients with malnutrition had significantly increased mortality rates compared with patients without malnutrition . Most studies that have explored the effects of malnutrition on LOS or mortality have had small sample sizes, were conducted internationally, or have used other validated screening tools . By validating these characteristics in larger hospital settings, we can demonstrate the importance of standardizing the data collection process and begin to elucidate relevant diseases or conditions associated with malnutrition.…”

Response to Comment on ‘Nutrition Screening vs Nutrition Assessment: What's the Difference?’

“…The latter undoubtedly facilitates the “practice” of non‐nutrition experts who are not familiar with SGA. It is unquestionable that the ASPEN/AND tool should be adequately validated, which has been attempted, to my knowledge, by 2 groups of authors in Portugal and in the United States, with interesting results.…”