Academic journal article Journal of Health Population and Nutrition

Determinants of Malnutrition and Post-Operative Complications in Hospitalized Surgical Patients

Academic journal article Journal of Health Population and Nutrition

Determinants of Malnutrition and Post-Operative Complications in Hospitalized Surgical Patients

Article excerpt

INTRODUCTION

The nutritional status of adult and elderly hospitalized patients has been discussed for years. The rates of malnutrition in this population usually depend on disease and assessment criteria and vary from 10% to 50% (1-3). However, the risk of malnutrition varied from 19% to 60% according to a British study (4), was 27.4% according to a German study (5), and 46% according to a Canadian study (6), Finally, a study in Spain found mild, moderate and severe malnutrition rates of 50.7%, 26.4%, and 5.7% respectively (7).

Recent studies in Brazil (8) found a malnutrition rate of 14.1% shortly after admission to hospital. These rates varied according to the assessment method.

Different parameters are being developed to assess the nutritional status of hospitalized patients and better map this reality (5-9). Nevertheless, malnutrition is still underreported (10), despite its association with increased morbidity, mortality, and hospital costs (10).

Malnutrition increases the risk of complications from abdominal surgery (11,12) but weight loss, low albumin, and low body mass index (BMI) are not always associated with mortality and morbidity in surgical patients (13). Although many studies have assessed the nutritional status of hospitalized patients, including some from this research group (8,14,15), the relationship between nutritional status and other variables, such as type of disease, type of surgery, and occurrence of complications, among others, should be further explored. Newfound Associations may help improve interventional actions and control strategies that aim to prevent malnutrition-related intercurrences.

The objective of this study was to determine the nutritional status of hospitalized surgical patients and investigate whether their nutritional status was associated with type of disease, type of surgery, and post-operative complications.

MATERIALS AND METHODS

This study was conducted at the university hospital (Hospital e Maternidade Celso Pierro) of the Pontifical Catholic University of Campinas, a large university in the state of Sao Paulo, Brazil, from 2010 to 2011, after approval from the local Research Ethics Committee. This university hospital is a tertiary-level hospital that routinely treats high-risk patients, such as those with polytrauma, and performs complex surgeries for cancer. Its catchment areas are the city of Campinas and the respective metropolitan regions.

The study is part of a research project called "Nutritional status of hospitalized patients and its relationship with disease, clinical and surgical variables, and length of hospital stay." Since the study location was the surgical ward, the study patients were surgical patients. The inclusion criteria were: nutritional status assessed within the first 24 hours of admission, age [greater than or equal to] 20 years, and availability of complete medical records. The exclusion criteria were: terminal patients, patients with oedema or ascites, patients undergoing haemodialysis, patients with psychiatric diseases, patients kept in isolation, patients of ocular surgery, and those admitted only for clinical investigation and/or tests. Bed-ridden patients or patients who could not talk were also excluded since their body-weight and habitual energy intake (HEI) could not be determined. At first, 512 adult and elderly patients (aged >60 years according to the Brazilian Elderly Statute) in the surgical ward were selected systematically but, after applying the selection criteria, 388 retained, constituting the final sample.

Data collection

A protocol was developed specifically for this study to collect the following data systematically from the patients' medical records during their stay: gender, age, length of stay (LOS) at the hospital, type of disease, type of surgery, post-operative complications, anthropometric indicators of nutritional status, laboratory test results, HEI, and number of medications prescribed during the stay. …

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