Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality
Lim, Su Lin, Ong, Kian Chung Benjamin , Chan, Yiong Huak , Loke, Wai Chiong , Ferguson, Maree , & Daniels, Lynne (2012) Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clinical Nutrition, 31(3), pp. 345-350.
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.
Impact and interest:
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|Item Type:||Journal Article|
|Keywords:||Malnutrition, Hospitalization outcomes, Mortality, Cost, Subjective Global Assessment, Prevalence|
|ISSN:||1532-1983 (online) 0261-5614 (print)|
|Subjects:||Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NUTRITION AND DIETETICS (111100)|
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700)
|Divisions:||Current > Institutes > Institute of Health and Biomedical Innovation|
Current > Schools > School of Exercise & Nutrition Sciences
Current > Schools > School of Public Health & Social Work
|Copyright Owner:||Copyright 2011 Elsevier Ltd. and European Society for Clinical Nutrition and Metabolism|
|Copyright Statement:||NOTICE: this is the author’s version of a work that was accepted for publication in Clinical Nutrition. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Clinical Nutrition, [Volume 31, Issue 3, (June 2012)] DOI: 10.1016/j.clnu.2011.11.001|
|Deposited On:||29 May 2012 07:48|
|Last Modified:||14 Sep 2013 01:22|
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