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Analysis

Boosting Surgical Patient Nutrition Slashes Readmissions

By Christopher Cheney  
   June 25, 2018

For surgical patients who received nutritional intervention in the hospital, the 30-day readmissions rate was cut nearly in half.

Compared to hospitalized medical patients, surgical patients benefit more from malnutrition screening and intervention, researchers say.

The study, which collected data from 1,269 patients in a nutrition-focused quality improvement program and 1,319 control patients, found the 30‐day readmission rate for surgical patients dropped nearly in half, falling from 19.6% to 10.4%.

"Malnourished hospitalized surgical and medical patients experienced improved readmission rates and length of stay. However, surgical patients saw a significantly greater reduction in the readmission rate," the researchers wrote.

For surgical patients, the readmissions rate was 22.3% for the control group and 17.7% for the quality improvement program patients.

Length of stay reductions were also greater for surgical patients, with LOS for surgical patients dropping 2.7 days, from 9.3 days to 6.6 days. Medical patients experienced a 2.1-day LOS decline, from 7.1 days to 5.0 days.

As many as 50% of patients are malnourished or at risk of malnutrition when they are admitted to a hospital. Surgical patients face high risk, the researchers wrote. "Surgical patients in particular are vulnerable to a decline in nutrition status during hospitalization."

The researchers say surgical patients face four primary nutrition-related risks during their hospitalization:

  • Delayed wound healing
     
  • Postoperative complications such as surgical site infections
     
  • Longer LOS
     
  • Higher readmission rates

Hospitals and surgeons should intervene when a surgical patient is malnourished, the researchers wrote. "The avoidance of nutrition therapy bears the risk of underfeeding, which will in turn result in significant postoperative complications."

For this study, which was published in the Journal of Parenteral and Enteral Nutrition and funded by Lake Bluff, Illinois-based Abbott, the nutrition-focused quality improvement program had four primary elements:

  • Malnutrition screening
     
  • For malnourished patients or patients at risk of being malnourished, oral nutrition supplements were provided in less than 48 hours
     
  • Nutrition information was provided for both the patient and caregivers
     
  • The electronic medical record triggered dietitian consultations and specified oral nutrition supplements depending on a patient's condition

With health outcomes and cost savings on the line, the researchers urge surgeons to embrace nutritional interventions for their patients.

"We particularly call surgeons to action—to raise awareness of the importance of nutrition on surgical outcomes, to partner with hospital administration to obtain appropriate support for nutrition care processes, and to expand nutrition education and training in residency and continuing medical education programs."

Training is a weak link in efforts to address malnourishment among medical and surgical patients, the researchers wrote.

"In a recent survey, 72% of managers of U.S. medical residency programs stated that an advanced course in nutrition should be required of residents. However, only a quarter of residency programs include a formal course in nutrition, and half of those are taught to family practitioners, not surgeons."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Malnutrition screening and intervention cut readmission rates nearly in half for surgical patients.

The initiatives slashed lengths of stay for surgical patients by 2.7 days.

Nutrition-focused programs use EMRs to trigger consultations with dietitians.


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