The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis

  • M Isabel T. D. Correia
    Department of Surgery, Faculdade de Medicina da, Universidade Federal de Minas Gerais, Brazil
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  • Dan L Waitzberg
    Department of Gastroenterology — Digestive Surgery Discipline, Faculdade de Medicina da, Universidade de São Paulo, Brazil (Correspondence to: MITDC, Department of Surgery, Faculdade de Medicina da, Universidade Federal de Minas Geris, Rua Gonçalves Dias 332 apt. 602 Belo Horizonte, MG 30140-090, Brazil)
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      Malnutrition has been identified as affecting patient outcome. The purpose of this study was to correlate the nutritional status of hospitalized patients with their morbidity, mortality, length of hospital stay and costs. The patients were nutritionally assessed within the first 72h of hospital admission. The patients’ charts were surveyed on the incidence of complications and mortality. Hospital costs were calculated based on economic tables used by insurance companies. Multivariate logistic regression analysis and the Cox regression model were used to identify possible confounding factors. A P<0.05 was considered statistically significant.
      The mean age was 50.6±17.3 years with 50.2% being male. The incidence of complications in the malnourished was 27.0% [Relative risk (RR)=1.60]. Mortality in the malnourished patients was 12.4% vs 4.7% in the well nourished (RR = 2.63). Malnourished patients stayed in the hospital for 16.7±24.5 days vs 10.1±11.7 days in the nourished. Hospital costs in malnourished patients were increased up to 308.9%.
      It was concluded that malnutrition, as analyzed by a multivariate logistic regression model, is an independent risk factor impacting on higher complications and increased mortality, length of hospital stay and costs.


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      1. Allison S P. Malnutrion, disease, and outcome. Nutrition 2000; 16: 590–591

      2. Chima C S, Barco K, Dewitt J L A, Maeda M, Teran J C, Mullen K D. Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service. Aliment Pharmacol Ther 1997; 11: 975–978

      3. Reinhardt G F, Jyscofski J W, Wilkiens D G, Dobrin P B, Mangan J E, Stannard R T. Incidence and mortality of hypoalbuminemic patients in hospitalized veterans. J Parenter Enteral Nutr 1980; 4: 357–359

      4. Robinson G, Goldstein M, Levin G M. Impact of nutritional status on DRG length of stay. J Parenter Enteral Nutr 1987; 11: 49–51

      5. Chandra R K, Kumary S. Effects of nutrition on the immune system. Nutrition 1994; 207–210

      6. Van Der Hulst R R, Von Meyenfeldt M F, Van Kreel B K. Gut permeability, intestinal morphology, and nutritional depletion. Nutrition 1998; 14: 1–6

      7. Efthimiou J, Fleming J, Gomes C, Spiro S G. Effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. Am Rev Resp Dis 1988; 137: 1075–1082

      8. Hill G L, Haydock D A. Impaired wound healing in surgical patients with varying degrees of malnutrition. J Parenter Enteral Nutr 1989; 10: 550–554

      9. Weinsier R L, Hunker E M, Krumdieck D L, Butterworth D E. Hospital malnutrition: a prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr 1979; 32: 418–426

      10. Butterworth C E. The skeleton in the hospital closet. Nutrition Today 1974; 9: 4–8

      11. Bistrian B R, Blackburn G L, Vitale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients. JAMA 1976; 235: 1567–1570

      12. Waitzberg D L, Caiaffa W T, Correia M I T D. Hospital malnutrition: the Brazilian national survey (Ibranutri): a study of 4000 patients. Nutrition 2001; 17: 575–580

      13. McWhirter J P, Pennington C R. Incidence and recognition of malnutrition in hospital. BMJ 1994; 308: 945–948

      14. Pagano M, Gauvreau K. Principles of Biostatistics. Belmont, Duxbury Press, 1993, 524p.

      15. Detsky A S, McLaughlin J R, Baker J P et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr 1987; 11: 8–13

      16. Buzby G P, Mullen J L, Matthews, D C. Prognostic nutritional index in gastrointestinal surgery. Am J Surg 1980; 139: 160–167

      17. Jeejeebhoy K N. Nutritional assessment. Nutrition 2000; 16: 585–589

      18. Agrady E, Messina V, Campanell G et al. Hospital malnutrition: incidence and prospective evaluation of general medical patients during hospitalization. Acta Vitaminol Enzymol 1984; 6: 235–237

      19. Anker S D, Ponikowsky P, Varney S et al. Wasting as independent risk factor for mortality in chronic heart failure. Lancet 1997; 349: 1050–1053

      20. Ek A C, Larsson J, Von Cchenck H, Throslun S, Unosson M, Bjurrulf P. The correlation between eanergy, malnutrition and clinical outcome in an elderly hospital population. Clin Nutr 1990; 9: 185–189

      21. Keys A, Brozek J, Henschel A. The Biology of Human Starvation. Minneapolis: University of Minnesota Press, 1950.

      22. Studley H O. Percentage of weight loss. A basic indicator or surgical risk in patients with chronic peptic ulcer. JAMA 1936; 106: 458–460

      23. Von Meyenfeldt M F, Jeijerink W J H J, Rouflart J M J, Builmaassen M T H J, Soeters P B. Perioperative nutritional support: a randomized clinical trial. Clin Nutr 1992; 11: 180–186

      24. Ljungqvist O, Nygren J, Thorell A. Insulin resistance in elective surgery. Surgery 2000; 128: 757–760

      25. Popper K R. The logic of scientific discovery. New York: Haper & Row, 1968.

      26. Zeiderman M R, McHahon M J. The role of objective measurement of skeletal muscle function in the pre-operative patient. Clin Nutr 1989; 8: 161–166

      27. Heymsfield S B, Bethel R A, Asley J D, Gibbs D M, Felner J M, Nutter D O. Cardiac abnormalities in cachectic patients before and during repletion. AM Heart J 1978; 95: 584–594

      28. Kahn H A, Sempos C T. Statistical methods in epidemiology. 2nd ed. New York: Oxford University Press, 1989