[Hospital malnutrition: relation between the hospital length of stay and the rate of early readmissions]

Abstract

Background and objective: In hospitalized patients, malnutrition ranges between 30% and 55% and is associated with a higher rate of complications, prolonged hospitalization and increased cost of health services. Despite this, there is no awareness of the clinical and economic implications involving hospital malnutrition and its treatment. We analyzed the relationship between hospital malnutrition, average length of stay and early readmissions.

Material and methods: It is a prospective and dynamic cohort study, in which patients were observed from the time of their admission and throughout their hospitalization on a weekly basis. The selection was carried out using a systematic random method. Patients were all older than 18 and admitted to the services with an average stay 5 days. It was decided that a patient had malnutrition when some anthropometric (biceps circumference, tricipital, abdominal and subscapular skinfold thickness) or biochemical (albumin, prealbumin, and transferrin) parameter was below normal values. Early readmission was defined as a patient's return to hospital in a period < 31 days from the last date of discharge. Hospital entries were classified in relation to the average stay (hospital and services) and we analyzed the stays below and the stays above the average expected. Results have been expressed in average and standard deviation (X +/- SD) and frequency (%). Intergroup comparisons by Student's t test and chi(2), remain significant to P < .05. The risk and confidence intervals (CI) were applied to malnourished cohorts, with a significance level of 95%.

Results: The study included 817 patients (50.9 +/- 18.5 years), 62.9% men and 37.1% women. 45.9% (n = 375) of patients were malnourished, and malnutrition was most common in those with digestive diseases (22.5%), neoplasm (20.8%), circulatory (16.5%) and respiratory pathologies (11.6%). The average stay (hospital and services) and the premature readmission rate were higher in patients admitted to hospital with malnutrition.

Conclusions: Nearly half of the patients presented some degree of malnutrition when they were admitted, increasing hospital stay and premature readmission rate. The high prevalence and incidence of malnutrition requires suggestions to develop mechanisms to determine its real scope and programs to solve it.