Cost-effectiveness of nutritional support

Economic impact of malnutrition: a model system for hospitalized patients

A retrospective review of 771 patients' charts in two acute care hospitals was performed to determine likelihood of malnutrition (LOM) at admission and to assess the effect of LOM on costs and charges. Using accepted criteria, LOM was present in 59 and 48% of medical and surgical patients, respectively. Patients with LOM were 2.6 or 3.4 times as likely to have a predefined minor or major complication, respectively; and 3.8 times as likely to die as patients without LOM (all p less than 0.001). In every diagnosis-related group, the mean length of stay was longer for LOM patients (range 1.1-12.8 excess days). Accountants converted charges to direct variable costs using departmental cost-to-charge ratios. LOM status increased excess costs and charges per patient by $1738 and $3557, respectively (p less than 0.0001). When complications occurred, LOM patients incurred $2996 or $6157 excess costs and charges per patient (p less than 0.01). Serum albumin was the strongest clinical predictor of cost. The hospitals' cost of providing enteral or parenteral nutrition support was $18 or $102 per day, respectively. Too few patients received early nutrition support to assess efficacy. Nonetheless, the costs associated with malnutrition warrant early detection and aggressive treatment.

The nutrition team in a children's hospital

This paper discusses the reasons for a paediatric nutritional care team, the members involved, and their role within the team. The methods used for nutritional assessment are described and the cost effectiveness of the nutrition team's involvement is discussed.

Malnutrition in patients with gastrointestinal malignancy. Significance and management

Malnutrition is a common accompaniment of gastrointestinal malignancy. The etiology of such malnutrition is multifactorial, but, when present, is a poor prognostic sign. Simple causes of decreased intake such as obstruction are readily overcome by distal enteral or parenteral feeding. Metabolic abnormalities that limit the efficacy of parenteral nutrition in such patients have been identified and, although not uniform, give further insight into the manner in which the host and the tumor partition energy and substrate. Widespread use of adjunctive parenteral nutrition in patients undergoing chemotherapy or radiation therapy for gastrointestinal malignancy has not improved tolerance or efficacy of such treatment. Nutritional support of the malnourished patient with a gastrointestinal cancer, prior to a major operation, has been shown to decrease perioperative morbidity and mortality.

Use of APACHE II severity of disease classification to identify intensive-care-unit patients who would not benefit from total parenteral nutrition

The APACHE II severity of disease classification system was tested for its ability to identify intensive-care-unit (ICU) patients who would not benefit from treatment with total parenteral nutrition (TPN). First, the classification was validated in our patient population by testing it on 210 consecutive ICU admissions. Then a retrospective study was done on 89 ICU patients who had received TPN, to define APACHE II selection criteria. When the APACHE II system was tested prospectively on 26 ICU patients treated with TPN, it predicted correctly, with a specificity of 100%, half of the patients who died.