Interrelationships between Dietary Outcomes, Readmission Rates and Length of Stay in Hospitalised Oncology Patients: A Scoping Review

Predictive value of the Rothman index for unplanned 90-day readmission rates following hospital discharge in oral cancer patients

This study aims to evaluate the predictive capability of the Rothman Index in determining unplanned readmissions within 90 days after discharge for oral cancer patients. The consecutive recruitment was carried out from May 1, 2020, to May 31, 2023, at the outpatient department of Ruijin Hospital of Medical College of Shanghai Jiao Tong University Shanghai Hospital. The evaluation is based on internationally recognized clinical evaluation indicators. A total of 125 recruited patients were grouped as per the presence (n=13) or absence (n=112) of unplanned readmissions within 90 days after discharge. Electronic medical records and patient follow-up records were used to collect details, including gender, age, body mass index, associated conditions such as diabetes and hypertension, treatment approach, and pathological type. In addition, the Rothman Index, postoperative complications, and rates of unplanned readmissions within 90 days post-discharge were assessed following previous literature. Although there was no significant difference in gender, body mass index, and length of hospital stay between the groups (P > 0.05), age, smoking and alcohol consumption history, and the Rothman Index exhibited significant variations (P < 0.05). The Rothman Index was found to be the most strongly correlated with unplanned readmissions within 90 days and could be incorporated in a prediction model. The area under the curve (AUC), as highlighted in the receiver operating characteristic (ROC) curve analysis, for predicting unplanned readmissions within 90 days post-discharge was 0.930, using Rothman Index. This suggests that the Rothman Index could be an effective tool in managing risk in clinical settings due to its potential to accurately predict the rate of unplanned readmissions for oral cancer patients within 90 days of discharge.

Development of a nutritional screening and assessment indicator system for patients with esophageal cancer in China: Findings from the Delphi method

BACKGROUND

In China, individuals diagnosed with esophageal cancer are confronted with an elevated risk of nutritional inadequacy or malnutrition throughout the course of their disease, a condition that contributes to various adverse clinical outcomes. A vast corpus of data are burgeoning at an unprecedented rate, primarily due to the revolutionary growth of digitalization technologies and artificial intelligence, notably within the domains of health care and medicine. The purpose of this investigation is to initiate the development of a nutritional screening and assessment indicator framework for patients with esophageal cancer within the Chinese context. We seek to furnish an instrumental reference to facilitate preparations for the forthcoming era of advanced, "deep," evidence-based medicine.

METHODS

An integrative methodology was employed to forge the preliminary draft of the nutritional screening and assessment indicator system for preoperative patients with esophageal cancer. This encompassed a rigorous literature survey, in-depth clinical practice investigation, and the facilitation of expert panel discussions. Thereafter, two iterative consultation phases were conducted using the Delphi method in China. The analytic hierarchy process was deployed to ascertain the weighting of each index within the definitive evaluation indicator system.

RESULTS

The effective response rates for the dual rounds of expert consultation were 91.7% and 86.4%, with commensurate authority coefficients of 0.97 and 0.91. The Kendall harmony coefficients were ascertained to be 0.19 and 0.14 (p < 0.01), respectively. The culminating nutritional screening and assessment indicator system for patients with esophageal cancer comprised 5 primary-level indicators and 38 secondary-level indicators.

CONCLUSIONS

The nutritional screening and assessment indicator system contrived for patients with esophageal cancer is underpinned by cogent theoretical principles, leverages an astute research methodology, and manifests dependable outcomes. This system may be appositely utilized as a meaningful reference for the nutritional screening and assessment process in patients afflicted with esophageal cancer.

Nutritional Intake, Hospital Readmissions and Length of Stay in Hospitalised Oncology Patients

BACKGROUND

Poor food intake is an independent risk factor for malnutrition in oncology patients, and achieving adequate nutrition is essential for optimal clinical and health outcomes. This study investigated interrelationships between nutritional intake and clinical outcomes in hospitalised adult oncology patients.

METHODS

Estimated nutrition intake data were obtained from patients admitted to a 117-bed tertiary cancer centre during May-July 2022. Clinical healthcare data, including length of stay (LOS) and 30-day hospital readmissions, were obtained from patient medical records. Statistical analysis, including multivariable regression analysis, assessed whether poor nutritional intake was predictive of LOS and readmissions.

RESULTS

No relationships between nutritional intake and clinical outcomes were evident. Patients at risk of malnutrition had lower mean daily energy (-898.9 kJ, p = 0.001) and protein (-10.34 g, p = 0.015) intakes. Increased malnutrition risk at admission prolonged LOS (1.33 days, p = 0.008). Hospital readmission rates were 20.2%, and associated with age (r = -0.133, p = 0.015), presence of metastases (r = 0.125, p = 0.02) and longer LOS (1.34 days, r = 0.145, p = 0.02). Sarcoma (43.5%), gynaecological (36.8%) and lung (40.0%) cancers had the highest readmission rates.

CONCLUSIONS

Despite research showing the benefits of nutritional intake during hospitalisation, evidence continues to emerge on the relationship between nutritional intake and LOS and readmissions that may be confounded by malnutrition risk and cancer diagnosis.