Impact of malnutrition on gastrointestinal surgical patients
Impact of malnutrition on gastrointestinal surgical patients
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DOI：
10.1016/j.jss.2016.05.030
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发表时间：
2016-09-01
影响因子：
2.2
通讯作者：
Fitzgerald, Timothy L.
中科院分区：
文献类型：
--
作者：
Mosquera, Catalina;Koutlas, Nicholas J.;Fitzgerald, Timothy L.
背景：如果我们要影响营养不良的结果，准确诊断营养不良是必不可少的。美国肠外和肠内营养学会（ASPEN）和营养与饮食学会（and）试图解决这一问题，提供了诊断营养不良的循证标准。本研究的目的是在一组来自单一大容量外科肿瘤单位的患者中验证ASPEN/AND标准。方法：采用ASPEN/AND标准对2013年6月至2015年3月接受腹部大手术的患者进行营养状况分类。结果：共纳入490例患者。中位年龄为64岁，大多数为女性（50.6%），白人（60.2%），接受选择性手术（77.6%），Charlson合并症评分（CCS）为3-5 (40.0%)，Clavien-Dindo并发症（CDC）等级为0-II（81.2%）。共有93例（19.0%）患者被划分为中度/重度营养不良。单因素分析显示，营养不良患者更可能年龄较大，接受紧急手术，并有CCS bbb50 （P < 0.05）。营养不良还与术后更长的住院时间（LOS）、更高的费用、更高的住院死亡率、更严重的并发症和更高的再入院率相关（P < 0.05）。多因素分析重申了营养不良、LOS（比值比[OR] = 1.67）和成本（OR = 2.49）之间的相关性，P < 0.05。并发症（OR = 1.35）、死亡率（OR = 3.05）、再入院率（OR = 1.34） P < 0.05均无统计学意义。结论：营养不良加重了LOS和成本。标准化标准的使用一致地识别可能受益于围手术期营养支持的患者的负面结果风险。(C) 2016 Elsevier Inc.版权所有。
Background: The accurate diagnosis of malnutrition is imperative if we are to impact outcomes in the malnourished. The American Society of Parenteral and Enteral Nutrition (ASPEN) and Academy of Nutrition and Dietetics (AND), in an attempt to address this issue, have provided evidence-based criteria to diagnose malnutrition. The purpose of this study was to validate the ASPEN/AND criteria in a cohort of patients from a single high-volume surgical oncology unit.Methods: Patients undergoing major abdominal surgery from June 2013 to March 2015 were classified by their nutritional status using the ASPEN/AND criteria.Results: A total of 490 patients were included. Median age was 64 y, a majority were female (50.6%), white (60.2%), underwent elective procedures (77.6%), had a Charlson comorbidity score (CCS) of 3-5 (40.0%), and a Clavien-Dindo complication (CDC) grade of 0-II (81.2%). A total of 93 (19.0%) patients were classified as moderately/severely malnourished. On univariate analysis, malnourished patients were more likely to be older, undergo emergent procedures, and have a CCS > 5 (P < 0.05). Malnutrition was also associated with a longer postoperative length of stay (LOS), higher cost, higher in-hospital mortality, more severe complications, and higher readmission rates (P < 0.05). Multivariate analysis reaffirmed the association between malnutrition, LOS (odds ratio [ OR] = 1.67), and cost (OR = 2.49), P < 0.05. Complications (OR = 1.35), mortality rates (OR = 3.05), and readmission rates (OR = 1.34) P > 0.05 failed to reach significance.Conclusions: Malnutrition worsens LOS and cost. Utilization of standardized criteria consistently identifies patients at risk of negative outcomes who may benefit from perioperative nutritional support. (C) 2016 Elsevier Inc. All rights reserved.