Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality
Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality
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DOI：
10.1016/j.clnu.2011.11.001
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发表时间：
2012-06-01
影响因子：
6.3
通讯作者：
Daniels, Lynne
中科院分区：
文献类型：
--
作者：
Lim, Su Lin;Ong, Kian Chung Benjamin;Daniels, Lynne
背景和目的：从未在多学科环境中使用诊断相关组（DRG）研究疾病对营养不良结果的混杂影响。本研究旨在确定新加坡三级医院营养不良的患病率及其对住院结果和费用的影响，并控制 DRG。方法：这项前瞻性队列研究包括一项匹配的病例对照研究。主观整体评估用于评估 818 名成人入院时的营养状况。根据性别、年龄、种族和 DRG 匹配对 3 年以上的住院结果进行调整。结果：营养不良患者 (29%) 的住院时间较长（6.9 +/- 7.3 天与 4.6 +/- 5.6 天，p < 0.001），并且更有可能在 15 天内再次入院（调整后相对风险 = 1.9，95% CI 1.1 -3.2，p = 0.025）。在 DRG 内，营养不良患者的实际住院费用与平均费用之间的平均差异大于营养良好的患者 (p = 0.014)。营养不良患者在 1 年（34% vs. 4.1%）、2 年（42.6% vs. 6.7%）和 3 年（48.5% vs. 9.9%）时的死亡率较高；全部 p < 0.001。总体而言，营养不良是死亡率的重要预测因素（调整后风险比 = 4.4，95% CI 3.3-6.0，p < 0.001）。结论：多达三分之一的住院患者存在明显的营养不良，导致住院结果和生存不佳，并且即使在 DRG 匹配后，也导致护理成本增加。需要制定预防和治疗医院内和出院后营养不良的策略。 (C) 2011 Elsevier Ltd 和欧洲临床营养与代谢学会。版权所有。
Background & aims: The confounding effect of disease on the outcomes of malnutrition using diagnosis-related groups (DRG) has never been studied in a multidisciplinary setting. This study aims to determine the prevalence of malnutrition in a tertiary hospital in Singapore and its impact on hospitalization outcomes and costs, controlling for DRG.Methods: This prospective cohort study included a matched case control study. Subjective Global Assessment was used to assess the nutritional status on admission of 818 adults. Hospitalization outcomes over 3 years were adjusted for gender, age, ethnicity, and matched for DRG.Results: Malnourished patients (29%) had longer hospital stays (6.9 +/- 7.3 days vs. 4.6 +/- 5.6 days, p < 0.001) and were more likely to be readmitted within 15 days (adjusted relative risk = 1.9, 95% CI 1.1 -3.2, p = 0.025). Within a DRG, the mean difference between actual cost of hospitalization and the average cost for malnourished patients was greater than well-nourished patients (p = 0.014). Mortality was higher in malnourished patients at 1 year (34% vs. 4.1 %), 2 years (42.6% vs. 6.7%) and 3 years (48.5% vs. 9.9%); p < 0.001 for all. Overall, malnutrition was a significant predictor of mortality (adjusted hazard ratio = 4.4, 95% CI 3.3-6.0, p < 0.001).Conclusions: Malnutrition was evident in up to one third of the inpatients and led to poor hospitalization outcomes and survival as well as increased costs of care, even after matching for DRG. Strategies to prevent and treat malnutrition in the hospital and post-discharge are needed. (C) 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.