Individualized measurement of disease-related malnutrition's costs.

BACKGROUND & AIMS: Disease-related malnutrition has a significant economic impact in hospitals, but accurate measurements of these costs have rarely been reported. The aim of this study is to calculate the actual costs of disease-related malnutrition in hospitals, taking into account every cost that patients generate during their hospital stay. METHODS: Patients admitted to medical wards were included in this study. Nutritional evaluation was carried out by two methods (Nutritional Risk Screening 2002 and Short Nutritional Assessment Questionnaire) at admission and/or at discharge. Hospitalization costs were measured for each patient individually, considering the cost of the bed, the Intensive Care Unit, the physicians' services, the laboratory tests and diagnostic procedures, and the drug costs. Differences in costs between malnourished patients and non-malnourished patients were calculated. RESULTS: Malnourished patients incurred higher costs than non-malnourished ones. The cost increase for malnourished patients ranged between 45% and 102%. The nutritional status accounted for most of this increase. The most outstanding difference in patients' costs was between those patients who maintained their nutritional status, either well or malnourished, during their hospital stay. CONCLUSIONS: Disease-related malnutrition clearly has an impact on the cost of hospital care provision, particularly in malnourished patients who do not improve their nutritional status during their hospital stays. Individualized cost analyses are needed to identify the real costs of malnutrition.

[Incidence of catheter-related infection and associated risk factors in hospitalized patients with parenteral nutrition]. / Incidencia de infección asociada a catéter y factores de riesgo relacionados en pacientes hospitalizados con nutrición parenteral.

INTRODUCTION: The most severe complication of parenteral nutrition (PTN) is catheter-related infection (CRI). OBJECTIVES: To study the incidence rate and factors associated to CRI. MATERIAL AND METHODS: 271 patients followed at the Nutrition Unit for 6 months. The composition of the PTN was calculated according to the metabolic demands. 20.3% received a lipid solution enriched with omega-3 fatty acids (SMOF Fresenius Kabi®) and 79.7% with olive oil (Clinoleic Baxter®). RESULTS: The rate of CRI was 25 per 1,000 days of PTN (55 patients: 61.7±17.8 years, 60.3% males, 29.3±10.6 days of hospital stay and 10.4% mortality). Coagulase-negative Staphylococcus was the most frequently isolated microorganism. There were no differences by age, gender, mortality, or composition of the PTN between patients with or without infection. The patients treated with omega-3 received more calories with the PTN, at the expense of higher intake of glucose and lipids. However, the rate of infection was similar, although there was a not significant trend towards a lower infection rate when using the omega-3 composition (14.5% vs. 23.1%, respectively, p = 0.112). The duration of the nutritional support was higher in patients with CRI (13.0 ± 9.7 vs. 9.3 ± 8.1, p = 0.038). Total mortality (16.9%) was independent of the presence or absence of CRI (10.4% vs. 18.7%, p = 0.090) or of the use of omega-3 lipids or olive oil in the PTN (10.9% vs. 18.5%, p = 0.125). CONCLUSION: Patients submitted to PTN have a high rate of CRI. The presence of infection is related to the duration of the PTN, being independent of the age, gender, and composition of the solution. The use of omega-3 lipid solutions may be beneficial although further studies are needed to confirm this.

Incidencia de infección asociada a catéter y factores de riesgo relacionados en pacientes hospitalizados con nutrición parenteral / Incidence of catheter-related infection and associated risk factors in hospitalized patients with parenteral nutrition

Introducción: La complicación más grave de la nutrición parenteral (NPT) es la infección asociada a catéter (IAC). Objetivos: Estudiar la tasa de incidencia y los factores asociados a IAC. Material y métodos: 271 pacientes seguidos por la Unidad de Nutrición durante seis meses. La composición de la NPT se calculaba de acuerdo a las necesidades metabólicas. Un 20,3% recibió la solución lipídica enriquecida con ácidos grasos omega3 (SMOF Fresenius Kabi®) y un 79,7% con aceite de oliva (Clinoleic Baxter®). Resultados: La tasa de IAC fue de 25 por 1.000 días de NPT (55 pacientes: 61,7 ± 17,8 años, 60,3% hombres, 29,3 ± 10,6 días de estancia y 10,4% mortalidad). El Staphiloccocus coagulasa negativo fue el germen aislado más frecuente. No existían diferencias en la edad, sexo, mortalidad y composición de la NPT entre pacientes con y sin infección. Los pacientes tratados con omega-3 recibían más calorías en la NPT, a expensas de mayor aporte de glucosa y de lípidos. Sin embargo, la frecuencia de infección era similar, aunque existía una tendencia no significativa a ser menor con el uso de omega-3 (14,5% vs 23,1% respectivamente, p = 0,112). La duración del soporte nutricional fue mayor en los enfermos con IAC (13,0 ± 9,7 vs 9,3 ± 8,1, p = 0,038). La mortalidad total (16,9%) fue independiente de si el paciente presentaba o no IAC (10,4% vs 18,7%, p = 0,090) o del uso de lípidos omega3 o aceite de oliva en la NPT (10,9% vs 18,5%, p = 0,125). Conclusión: Los pacientes sometidos a NPT cursan con una tasa elevada de IAC. La presencia de infección se relaciona con la duración de la NPT, siendo independiente de la edad, sexo y composición de la solución. El uso de soluciones lipídicas con omega-3 podría ser beneficiosa, aunque se necesitan más estudios para su confirmación (AU)

Introduction: The most severe complication of parenteral nutrition (PTN) is catheter-related infection (CRI). Objectives: To study the incidence rate and factors associated to CRI. Material and methods: 271 patients followed at the Nutrition Unit for 6 months. The composition of the PTN was calculated according to the metabolic demands. 20.3% received a lipid solution enriched with omega-3 fatty acids (SMOF Fresenius Kabi®) and 79.7% with olive oil (Clinoleic Baxter®). Results: The rate of CRI was 25 per 1,000 days of PTN (55 patients: 61.7±17.8 years, 60.3% males, 29.3±10.6 days of hospital stay and 10.4% mortality). Coagulase-negative Staphylococcus was the most frequently isolated microorganism. There were no differences by age, gender, mortality, or composition of the PTN between patients with or without infection. The patients treated with omega-3 received more calories with the PTN, at the expense of higher intake of glucose and lipids. However, the rate of infection was similar, although there was a not significant trend towards a lower infection rate when using the omega-3 composition (14.5% vs. 23.1%, respectively, p = 0.112). The duration of the nutritional support was higher in patients with CRI (13.0 ± 9.7 vs. 9.3 ± 8.1, p = 0.038). Total mortality (16.9%) was independent of the presence or absence of CRI (10.4% vs. 18.7%, p = 0.090) or of the use of omega-3 lipids or olive oil in the PTN (10.9% vs. 18.5%, p = 0.125). Conclusion: Patients submitted to PTN have a high rate of CRI. The presence of infection is related to the duration of the PTN, being independent of the age, gender, and composition of the solution. The use of omega-3 lipid solutions may be beneficial although further studies are needed to confirm this (AU)