Nutritional screening for risk prediction in patients scheduled for extra-abdominal surgery

Differences Between NRS-2002 and MUST in Relation to the Metabolic Condition of Trauma Patients

Introduction: Flow phase with high cardiac output and increased metabolic conditions. When metabolic conditions are not stable there will be a long duration of complications until death. One of the benefits of Nutrition Risk Screening (NRS-2002) is reliable inpatient care for critical patients. While the Malnutrition Universal Screening Tool (MUST) shows speed in the classification of nutritional disorders.Methods: This study used the observational design method. The sampling technique in this study used Consecutive sampling in accordance with the criteria consisting of 31 respondents. This was to determine the specificity and sensitivity values of NRS 2002 and MUST using contingency table analysis and for the Area Under Curve (AUC) using Receiver Operating Characteristic (ROC) curve analysis.Results: The sensitivity values in MUST was predicted for metabolic conditions which was higher than when using NRS 2002, but the specificity and value of AUC (Area Under Curve) was higher using NRS 2002 than using MUST when it came to predicting metabolic conditions.Conclusions: There were differences in effectiveness between use of Nutritional Risk Screening (NRS-2002) with the Malnutrition Universal Screening Tool (MUST) in relation to changes in metabolic conditions of trauma patients. NRS-2002 is more effective than MUST. NRS 2002 has the ability to identify patients more precisely who are likely to have a negative outcome.

Clinical impact of malnutrition on complication rate and length of stay in elective ENT patients: a prospective cohort study

Malnutrition is considered as an independent risk factor for morbidity, mortality and a prolonged hospital stay for in-hospital patients. While most available data on the impact of malnutrition on health-related and financial implications refer to gastroenterologic or abdominal surgery patients, little is known about the impact of malnutrition on Ear Nose Throat (ENT)/head and neck surgery patients. The objective of this study was to investigate the impact of malnutrition on morbidity and length of hospital stay in an elective ENT/head and neck surgery patient cohort. The study was performed as a single-center, prospective cohort study at a tertiary referral centre. Nutritional risk at admission was assessed using the NRS-2002 screening tool. Multivariate regression models were used to determine independent risk factors for complications and a prolonged hospitalization. Three hundred fifty one participants were included in the study. A malignant disease was found in 62 participants (17.7 %). 62 patients (17.7 %) were at a moderate to severe risk of malnutrition. A bad general health condition and complications during hospital stay could be identified as independent risk factors for a prolonged hospitalization. Patients with a malignant tumor showed a more than fourfold higher risk of developing at least one complication. Malnutrition, however, was not statistically associated with a higher complication rate or a prolonged hospital stay. Our data suggests that malnutrition does not seem to play such an important role as a risk factor for complications and a prolonged hospital stay in ENT patients as it does in other disciplines like abdominal surgery or gastroenterology.

Association between nutritional risk and routine clinical laboratory measurements and adverse outcomes: a prospective study in hospitalized patients of Wuhan Tongji Hospital

Background/Objectives:

Nutritional risk screening (NRS-2002) and routine clinical laboratory measurements (RCLMs) had been shown to have a predictive value in adverse outcomes in some studies, respectively. This study analyzed the association between NRS-2002 and RCLMs and estimated their prospective value in predicting adverse outcomes.

Subjects/Methods:

A total of 916 hospitalized patients were screened on admission with NRS-2002 and Subjective Global Assessment; RCLMs, which include blood test, kidney and liver function and electrolytes, were recorded. Diagnosis, nutritional support, surgery, radiotherapy, chemotherapy, complications, mortality and hospital stay during hospitalization were collected. The X²-test, odds ratios with 95% confidence intervals, kappa (k) statistic and regression analyses were conducted.

Results:

An overall 48.1% of the 916 patients were at nutritional risk on admission. Comparing ‘at risk' with ‘no risk', a significantly higher incidence of abnormality was found not only in nutritional markers but also in other parameters of RCLMs (OR ranged from 1.5 to 3.5). Regression analyses showed that ‘at risk' determined at admission was not a significant predictor of adverse outcomes after adjusting for other confounding factors, although it was a strong predictor in univariate analysis, whereas hypoalbuminemia, low total lymphocyte count, abnormality of hepatic and renal function were predictors after adjusting for confounders.

Conclusions:

The findings suggest that NRS-2002 might be a global index of ‘sickness' rather than be only a nutritional screening tool. It being rated once at admission is insufficient and should be repeated for using it as a predictor, whereas RCLMs routinely measured at admission may be able to be used to predict adverse outcomes.

Impact of malnutrition on propofol consumption and recovery time among patients undergoing laparoscopic gastrointestinal surgery

BACKGROUND

Malnutrition is a major health problem, especially in hospitalized patients as it can be closely related to many post-operative complications. However, research on malnutrition and its effect on the outcome of general anesthesia have been largely neglected. Here we investigated malnutrition status on propofol consumption and recovery time among patients undergoing laparoscopic gastrointestinal surgery under general anesthesia.

METHODS

One hundred and one patients were recruited between January and June 2012 at Tongji Hospital and assigned into three groups according to Nutritional Risk Screening Tool 2002 score. A standard combined general anesthesia procedure was performed under regular monitoring. The dosage of propofol needed for induction, consumption during maintenance and recovery time were recorded.

RESULTS

When compared with normal nutritional status individuals, the propofol dosage at induction was significantly decreased about 4.3% in moderate malnutritional status patients (P < 0.01) and about 16.8% in severely malnutritional status patients (P < 0.01). The average consumption of propofol was also significantly lower in malnourished individuals; for moderate malnutritional, the decrease was about 20% (P < 0.01) while for the severely malnutritional, it was 30% (P < 0.01) when compared with normal nutritional status individuals. For the recovery time of propofol anesthesia, the patients with severe malnutritional status awoke average 6.8 min later than those normally nourished (P < 0.01), but those patients with moderate malnutrition status did not (P = 0.885).

CONCLUSION

The present results indicate that the dosage and recovery time of propofol does change in malnourished individuals. Therefore, malnutrition may somehow affect the outcome of general anesthesia.