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Vol. 216. Num. 9.December 2016
Pages 461-514
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Vol. 216. Num. 9.December 2016
Pages 461-514
Original article
DOI: 10.1016/j.rceng.2016.07.001
Clinical and financial implications of disease-related malnutrition in a department of Internal Medicine: Prospective cohort study
Repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en un servicio de Medicina Interna: estudio de cohortes prospectivas
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M.D. Ballesteros-Pomara,
Corresponding author
, A. Calleja-Fernándeza, M. González-Valdésb, B. Pintor-de la Mazaa, R. Villar Taiboa, A. Vidal-Casariegoa, A. Urioste-Fondoa, B. Torres-Torresc, D. de Luis-Románc, I. Cano-Rodrígueza
a Unidad de Nutrición Clínica y Dietética de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain
b Medicina Interna, Complejo Asistencial Universitario de León, León, Spain
c Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Tables (4)
Table 1. Patient characteristics according to the malnutrition screening at admission.
Table 2. Characteristics of patients with severe malnutrition at admission.
Table 3. Characteristics of the patients whose nutritional status deteriorated during hospitalization.
Table 4. Medians of the total expenses and antibiotic expenses during each hospitalization for the malnourished patients at admission, malnourished during hospitalization or severely malnourished (Yes columns) compared with those who were not malnourished at admission, during hospitalization or severely malnourished, respectively (No columns).
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Abstract
Background

Disease-related malnutrition is a challenge for Spanish hospitals. Our objective was to assess the feasibility and importance of establishing a nutritional screening strategy in our community.

Patients and methods

A prospective cohort study was conducted in a department of internal medicine for 3 months. The nutritional screening was conducted at admission and was repeated weekly using the Malnutrition Universal Screening Tool. We analysed the clinical data, mean stay and expenses.

Results

The study included 330 patients (53.9% men), with a mean age of 77.8 years. The mean stay was 7 days, and the Charlson comorbidity index was 5.4. At admission, the Malnutrition Universal Screening Tool detected 26.9% of patients with a risk of malnutrition. Eighteen percent of the patients with a good nutritional state developed malnutrition during the hospitalisation. The patients with initially severe malnutrition had a longer mean stay. The patients whose nutritional state worsened during the hospitalisation had a significantly longer stay (2.5 days) compared with those whose state did not worsen. These cases of malnutrition caused a cost overrun of €767 per hospitalisation (35% greater), which entailed a malnutrition-related excess expenditure of €646,419.93 annually in the studied department. The appropriate coding resulted in an increase in mean weight from 2.11 to 2.81, which represented €82,568.52 and has not been previously quantified.

Conclusion

The high prevalence and clinical and financial implications of disease-related malnutrition in patients hospitalised in internal medicine warrants establishing protocols for its early detection and treatment.

Keywords:
Disease-related malnutrition
Nutritional support
Healthcare costs
Resumen
Introducción

La desnutrición relacionada con la enfermedad es un reto en nuestros hospitales. Nuestro objetivo fue valorar la factibilidad e importancia de establecer una estrategia de cribado nutricional en nuestro medio.

Pacientes y métodos

Estudio de cohortes prospectivo en un servicio de Medicina Interna durante 3 meses. El cribado nutricional se realizó al ingreso y se repitió semanalmente mediante la herramienta Malnutrition Universal Screening Tool. Se analizaron los datos clínicos, la estancia media y los gastos.

Resultados

Se incluyeron 330 pacientes (53,9% varones), con una edad media de 77,8 años; la estancia mediana fue de 7 días, y el índice de comorbilidad de Charlson de 5,4. La herramienta Malnutrition Universal Screening Tool detectó al ingreso un 26,9% de pacientes con riesgo de desnutrición. Un 18% de pacientes con buen estado nutricional desarrollaron desnutrición durante la hospitalización. Los pacientes con desnutrición grave inicial presentaron una estancia mediana mayor. Los pacientes cuya situación nutricional empeoró durante el ingreso tuvieron una estancia significativamente mayor (2,5 días) con respecto a los que no empeoró. Además, ocasionaron un sobrecoste de 767€ por ingreso (35% superior), lo que implica un exceso de gastos relacionados con la desnutrición de 646.419,93 € anuales en el servicio estudiado. La adecuada codificación implicó un incremento en el peso medio de 2,11 a 2,81, lo que supondría 82.568,52€, que no se habrían cuantificado previamente.

Conclusión

La alta prevalencia y repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en los pacientes ingresados en Medicina Interna hacen recomendable establecer protocolos para su detección precoz y tratamiento.

Palabras clave:
Desnutrición relacionada con la enfermedad
Soporte nutricional
Costes sanitarios

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