Being “Nutritionally at Risk”: Its Effect on Health Expenses and Length of Hospital Stay Nutritional Risk: Health Expenses and Length of Hospital Stay

Main Article Content

Anıl Evrim Güngör https://orcid.org/0000-0001-5936-3605
Fatma Nişancı Kılınç
İrem Alparslan
Biriz Çakır
Esma Asil
A. Ezel Esatoğlu
Yasemin Yavuz
Seher Demirer

Keywords

Malnutrition, Nutritional risk, Hand grip strength, Health expenses, Length of hospital stay

Abstract

Objective: Hospital malnutrition is a critical, cost-increasing public health problem that is common in many countries. The study aimed to evaluate the effect of “being nutritionally at risk” on health expenses and length of stay (LOS) in hospital. Material and Method: Nutritional Risk Screening-2002 (NRS-2002) was used to screen 1069 adult patients on admission day. Patients’ anthropometric measurements, unintentional weight loss, hand grip strength (HGS), cancer diagnosis, as well as LOS were recorded. Health expenses for each patient was obtained from hospital billing system. Results: Of the patients, 19.1% had NRS-2002³3 (nutritionally at risk) which was more frequent among male patients (61.8%) than female patients (38.2%) (p<0.001). The odds of being nutritionally at risk increased by 1.029 times with one year increase in age (p<0.05). The median of HGS was lower in patients with NRS-2002³3 (p<0.05). Patients without nutritional risk (NRS-2002<3) had a LOS of 7.65±7.61 days, while corresponding figure was 16.5±15.64 days for patients with NRS-2002³3 (p<0.001). Patients’ health expenses with NRS-2002<3 and NRS-2002³3 were $384.19 and $873.89, respectively (p<0.01). One percent increase in involuntary weight loss and one unit decrease in HGS resulted in $2588 and $1066 increase in average expenses, respectively (p<0.05). The odds of becoming NRS-2002≥3 increased 1.566 times with 1% increase of involuntary weight loss (p<0.001). Cancer patients whose average LOS was 4.5 days longer had 4.93 times increased risk of developing nutritional risk during hospital stay (p<0.001). Conclusion: Nutritional status of patients should be assessed during hospitalization. Patients with nutritional risk have higher total costs and stay longer in the hospital than the patients with no risk.

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References

1. Buitrago G, Vargas J, Sulo S, Partridge JS, Guevara-Nieto M, Gomez G, et al. Targeting malnutrition: Nutrition programs yield cost savings for hospitalized patients. Clin Nutr 2020;39(9):2896-901.
2. Freijer K, Tan SS, Koopmanschap MA, Meijers JM, Halfens RJ, Nuijten MJ. The economic costs of disease related malnutrition. Clin Nutr 2013;32(1):136-41.
3. Mueller C, Compher C, Ellen DM, American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. A.S.P.E.N. clinical guidelines: Nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr 2011;35(1):16-24.
4. Badosa EL, Tahull MB, Casas NV, Sangrador GE, Méndez CF, Meseguer IH, et al. Hospital malnutrition screening at admission: malnutrition increases mortality and length of stay. Nutr Hosp 2017;34(4):907-13.
5. Korfali G, Gundogdu H, Aydintug S, Bahar M, Besler T, Moral AR, et al. Nutritional risk of hospitalized patients in Turkey. Clin Nutr 2009;28(5):533-7.
6. Gungor AE, Arslan P, Abbasoglu O. A study of nutritional status, development of malnutrition and food consumption in hospitalized patients. Int J Emerg Trend Health Sci 2019;3(2):66-80.
7. Celik ZM, Islamoglu AH, Sabuncular G, Toprak HS, Gunes FE. Evaluation of malnutrition risk of inpatients in a research and training hospital: A cross-sectional study. Clin Nutr ESPEN 2021;41:261-7.
8. Jie B, Jiang ZM, Nolan MT, Efron DT, Zhu SN, Yu K, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition 2010;26(11-12):1088-93.
9. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22(4):415-21.
10. Hersberger L, Bargetzi L, Bargetzi A, Tribolet P, Fehr R, Baechli V, et al. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial. Clin Nutr 2020;39(9):2720-9.
11. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27(1):5-15.
12. Khalatbari-Soltani S, Marques-Vidal P. The economic cost of hospital malnutrition in Europe; a narrative review. Clin Nutr ESPEN 2015;10(3):e89-e94.
13. Curtis LJ, Bernier P, Jeejeebhoy K, Allard J, Duerksen D, Gramlich L, et al. Costs of hospital malnutrition. Clin Nutr 2017;36(5):1391-6.
14. Goates S, Du K, Braunschweig CA, Arensberg MB. Economic burden of disease-associated malnutrition at the state level. PLoS One 2016;11(9):e0161833.
15. Fingar KR, Weiss AJ, Barrett ML, Elixhauser A, Steiner CA, Guenter P, et al. All-cause readmissions following hospital stays for patients with malnutrition, 2013: Statistical brief #218. 2016 Dec. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs Rockville (MD): Agency for Healthcare Research and Quality (US); 2006.
16. Bolayir B, Arik G, Yeşil Y, Kuyumcu ME, Varan HD, Kara Ö, et al. Validation of Nutritional Risk Screening‐2002 in a hospitalized adult population. Nutr Clin Prac 2019;34(2):297-303.
17. Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement. Clin Nutr 2015;34(3):335-40.
18. Hillman T, Nunes Q, Hornby S, Stanga Z, Neal K, Rowlands B, et al. A practical posture for hand grip dynamometry in the clinical setting. Clin Nutr 2005;24(2):224-8.
19. Datar SM, Rajan MV. Horngren’s Cost Accounting: A Managerial Emphasis. 16th. Essex, England: Pearson; 2018. 48-86.
20. Bhatia HSM. Cost Accounting. Mumbai, India: Global Media; 2010.
21. Mooney K. The Essential Accounting Dictionary. 1st. Naperville (IL), USA: Sphinx Publishing; 2008.
22. Ljungqvist O, Van Gossum A, Sanz ML, De Man F. The European fight against malnutrition. ClinNutr 2010;29(2):149-50.
23. Zhou X, Wu X, Deng B, Huang L. Comparative survey on nutrition risk and nutrition support among hospitalized general surgery patients over a 7‐year period. JPEN J Parenter Enteral Nutr 2020;44(8):1468-74.
24. Sauer AC, Goates S, Malone A, Mogensen KM, Gewirtz G, Sulz I, et al. Prevalence of malnutrition risk and the impact of nutrition risk on hospital outcomes: results from nutritionDay in the US. JPEN J Parenter Enteral Nutr 2019;43(7):918-26.
25. Álvarez Hernández J, Planas Vilá M, León Sanz M, Garcia de Lorenzo y Mateos A, Celaya Pérez S, García Lorda P, et al. Prevalence and costs of multinutrution in hospitalized patients; the PREDyCES study. Nutr Hosp 2012;27(4):1049-59.
26. Simzari K, Vahabzadeh D, Saeidlou SN, Khoshbin S, Bektas Y. Food intake, plate waste and its association with malnutrition in hospitalized patients. Nutr Hosp 2017;34(6):1376-81.
27. Jensen GL, Hsiao PY and Wheeler D. Adult nutrition assessment tutorial. JPEN J Parenter Enteral Nutr 2012;36(3):267-74.
28. Jensen GL, Cederholm T, Correia MIT, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community. JPEN J Parenter and Enteral Nutr 2019;43(1):32-40.
29. Klek S, Krznaric Z, Gundogdu RH, Chourdakis M, Kekstas G, Jakobson T, et al. Prevalence of malnutrition in various political, economic, and geographic settings. JPEN J Parenter Enteral Nutr 2015;39(2):200-10.
30. Rinninella E, Cintoni M, De Lorenzo A, Addolorato G, Vassallo G, Moroni R, et al. Risk, prevalence, and impact of hospital malnutrition in a tertiary care referral university hospital: a cross-sectional study. Intern Emerg Med 2018;13(5):689-97.
31. Hiller LD, Shaw RF, Fabri PJ. Difference in composite end point of readmission and death between malnourished and nonmalnourished veterans assessed using Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition clinical characteristics. JPEN J Parenter Enteral Nutr 2017;41(8):1316-24.
32. Guerra RS, Fonseca I, Pichel F, Restivo MT,Amaral TF. Usefulness of six diagnostic and screening measures for undernutrition in predicting length of hospital stay: a comparative analysis. J Acad Nutr Diet 2015;115(6):927-38.
33. Hudson L, Chittams J, Griffith C,Compher C. 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. JPEN J Parenter Enteral Nutr 2018;42(5):892-7.
34. Ruiz AJ, Buitrago G, Rodríguez N, Gómez G, Sulo S, Gómez C, et al. Clinical and economic outcomes associated with malnutrition in hospitalized patients. Clin Nutr 2019;38(3):1310-6.
35. Bhirommuang N, Komindr S, Jayanama K. Impact of nutritional status on length of stay and hospital costs among patients admitted to a tertiary care hospital in Thailand. Asia Pac J Clin Nutr 2019;28(2):252-9.
36. De Santiago JLG, Valdez SA, Robles MLC, Veloz IG, Cisneros VO, de la Luz Martínez-Fierro M. Screening of nutritional risk: assessment of predictive variables of nutritional risk in hospitalized patients in a second-level care center in Mexico. Nutr Hosp 2019;36(3):626-32.
37. Norman K, Stobäus N, Gonzalez MC, Schulzke J-D, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr 2011;30(2):135-42.
38. McNicholl T, Curtis L, Dubin JA, Mourtzakis M, Nasser R, Laporte M, et al. Handgrip strength predicts length of stay and quality of life in and out of hospital. Clin Nutr 2020;39(8):2501-9.
39. Matos L, Tavares M,Amaral T. Handgrip strength as a hospital admission nutritional risk screening method. Eur J Clin Nutr 2007;61(9):1128-35.
40. Guerra RS, Amaral TF, Sousa AS, Pichel F, Restivo MT, Ferreira S, et al. Handgrip strength measurement as a predictor of hospitalization costs. Eur J Clin Nutr 2015;69(2):187-92.
41. Arends J, Baracos V, Bertz H, Bozzetti F, Calder P, Deutz N, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr 2017;36(5):1187-96.
42. Planas M, Álvarez-Hernández J, León-Sanz M, Celaya-Pérez S, Araujo K, De Lorenzo AG. Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES® study. Support Care Cancer 2016;24(1):429-35.
43. Almasaudi AS, McSorley ST, Dolan RD, Edwards CA, McMillan DC. The relation between Malnutrition Universal Screening Tool (MUST), computed tomography–derived body composition, systemic inflammation, and clinical outcomes in patients undergoing surgery for colorectal cancer. Am J Clin Nutr 2019;110(6):1327-34.
44. Amaral TF, Matos LC, Tavares MM, Subtil A, Martins R, Nazare M, et al. The economic impact of disease-related malnutrition at hospital admission. Clin Nutr 2007;26(6):778-84.
45. Gastalver-Martin C, Alarcon-Payer C,Leon-Sanz M. Individualized measurement of disease-related malnutrition's costs. Clin Nutr 2015;34(5):951-5.
46. Khalatbari-Soltani S,Marques-Vidal P. Impact of nutritional risk screening in hospitalized patients on management, outcome and costs: A retrospective study. Clin Nutr 2016;35(6):1340-6.
47. Stollhof LE, Braun JM, Ihle C, Schreiner AJ, Kufeldt J, Adolph M, et al. The continuous downgrading of malnutrition in the German DRG system: possible effects on the treatment of patients at risk for malnutrition. EXCLI J 2019;18(370-81.
48. Thomas MN, Kufeldt J, Kisser U, Hornung HM, Hoffmann J, Andraschko M, et al. Effects of malnutrition on complication rates, length of hospital stay, and revenue in elective surgical patients in the G-DRG-system. Nutrition 2016;32(2):249-54.

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