Nutritional screening in hospitalized patients with vascular disease-the relationship of nutritional risk with clinical and economic outcomes in a surgery department

Abstract

Introduction: Disease-related malnutrition has a negative impact on the outcome in surgical patients. Our objective was to assess the prevalence of nutritional risk in the field of vascular surgery, as well as its consequences on patient outcome and health expenditure. Patients and methods: This is a prospective, observational study conducted during 6 months in a vascular surgery ward at the University Hospital of León, Spain. The Malnutrition Universal Screening Tool was used to obtain data on admission and then every 7 days until hospital discharge. Clinical variables, surgical intervention performed, medical-surgical complications, hospital stay, healthcare costs, and early readmissions were studied. Results: A total of 104 patients, 84.6% males, with a mean age of 69 (SD: 13) years were enrolled. Of these, 46.2% were admitted due to peripheral arterial disease; 10.6% had a positive MUST at the time of admission and 19.2% at discharge; 100% of malnourished patients at admission remained in the same situation at discharge. During hospitalization, in 29 patients (27.9%) the nutritional situation worsened. In all, 81.25% of patients who experienced worsening of their MUST score had been admitted urgently (p<0.05). Patients who required urgent surgery significantly worsened in terms of their nutritional status (p<0.001). Patients with worsening nutritional status obtained higher rates for: Surgical reintervention (p<0.05), pharmaceutical expense (p=0.017), total hospital expense (€1,000/patient/admission), transfers to chronic care centers (p=0.0002), and number of early readmissions (p=0.017). Conclusion: Patients with nutritional risk suffered an increase in medical-surgical complications, hospital stay, healthcare costs, and re-admission rates. Therefore, we consider that an implementation of screening procedures and the development of further studies in the vascular surgery setting are necessary.