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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
Author(s) -
Hudson Lauren,
Chittams Jesse,
Griffith Cody,
Compher Charlene
Publication year - 2018
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1021
Subject(s) - medicine , malnutrition , odds ratio , parenteral nutrition , confidence interval , hazard ratio , enteral administration , population , retrospective cohort study , logistic regression , comorbidity , proportional hazards model , pediatrics , emergency medicine , environmental health
Background Few studies have compared malnutrition identified by the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) consensus criteria with clinical outcomes. Our goal was to compare 30‐day readmissions (primary outcome), hospital mortality, length of stay (LOS) in survivors, and time to discharge alive (TDA) in all patients assessed as malnourished or not malnourished using these criteria in fiscal year 2015. We hypothesized more frequent admissions, greater mortality, longer LOS, and less likely shorter TDA in the malnourished patients. Methods Demographic variables, clinical outcomes, and malnutrition diagnosis for all initial patient admissions were obtained retrospectively from the electronic medical record. Logistic regression was used to compare categorical and Cox proportional hazards for TDA in unadjusted and adjusted (age, sex, race, medical/surgical admission, Charlson Comorbidity Index) models. Results Of the 3907 patients referred for nutrition assessment, 66.88% met criteria for moderate or severe malnutrition. Malnourished patients were older (61 vs 58 years, P < .0001), and survivors had longer LOS (15 vs 12 days, P = .0067) and were more likely to be readmitted within 30 days (40% vs 23%, P < .0001). In adjusted models, 30‐day readmissions (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.82–2.48) and hospital mortality (OR 1.47, 95% CI 1.0–1.99) were increased, and the likelihood of earlier TDA was reduced (hazard ratio [HR] 0.55, 95% CI 0.44–0.77) in those who had >2‐day stay. Conclusion The AND/ASPEN criteria identified malnourished patients in a high‐risk population who had more adverse clinical outcomes. Further studies are needed to determine whether optimal provision of nutrition support can improve these outcomes.