| Background&AimsThe patients at nutritional risk have possibility to benefit fromnutritional support.It was been recommended to use screening tools whenpatients admitted by American Society for Parenteral and EnteralNutrition and The European Society for clinical Nutrition AndMetabolism, Chinese Society for Parenteral and Enteral Nutrition as well.Several studies have reported data on the prevalence of malnutrition andnutritional risk and of nutrition support practice in China and the US, andof the clinical effect of nutrition support on clinical outcome. However, nooutcome data combined with a cost/effectiveness analysis were publishedin China or the US.The aims of this study were1) to investigate the prevalence ofnutritional risk and malnutrition and nutrition support in patients, and2) toexamine the impact of nutritional support on the clinical outcome for thegastrointestinal patients who were at nutritional risk and identified by NRS2002to contrast the cost effectiveness of a nutrition support cohortwith that of a non-nutrition support cohort.MethodsIt was a prospective observational cohort study. Approved by EthicCommittee and informed consents were obtained from each patients.Patients consecutively admitted and all patients basic data were recordedfrom the department of gastroenterology， gastrointestinal surgery，neurology and respiratory were consecutively recruited from June2011toJuly2012，and use Nutritional risk screening2002to screen the nutritionalrisk. Information regarding nutrition support, treatment, complications andlength of hospital stay were recorded at least4times per week. The directcosts of the nutritional support, the costs of diagnosing and treatment forthe infectious complications and the indirect costs were calculated in detail.The rate of “infectious complication-free” patients was regarded as theindex of the effectiveness. The cost effectiveness ratios were analyzed.ResultsA total of3679patients were screened for nutritional risk. Theprevalence of nutritional risks in gastroenterology，gastrointestinal surgery，neurology and respiratory was35.0%,45.4%and11.8%,32.0%respectively.The patients at nutritional risk in gastroenterology， gastrointestinalsurgery， received nutrition support was15.3%,42.6%respectively. Therewere no patients at nutritional risk accepted nutrition support in neurology and respiratory ward.The final analysis included440cases that fit the all requirements ofcohort study inclusion criteria, and those patients were at nutritional risk.There were19patients in the nutrition support cohort who encounteredcomplications while there were51patients in without nutrition supportcohort had complications. The patients in nutritional support cohort hadlower incidence of the complications than the patients in nutrition supportcohort (10.2%versus20.1%P=0.004). This was mainly because of alower rate of infectious complications(9.1%versus18.1%P=0.007).TheLOSNDIin the nutrition support cohort was12d(11d,13d) versus14d(12d,18d) in the no support cohort (P <0.001).The actual LOS in thenutrition support cohort was15d(12d,18d)versus,15d(12d,19d)in the nosupport cohor(tP=0.598).The total cost of the nutrition support cohort wasCNY2454(2000,3074)/patient, compared to the average total cost of thecohort without nutrition support: CNY754(616,960)/patient. Theeffectiveness, expressed by the “infectious complication-free rate” was90.9%and81.9%in the nutrition support cohort and the non-nutritionsupport cohort, respectively. Cost-effectiveness ratios were CNY2700(2200,3382)/patient, CNY921(752,1172)/patient respectively.ConclusionThe incidence of nutritional risk and nutrition support was higher indepartment of gastroenterology. And the nutrition support was associated with a higher cost-effectiveness ratio，but it decreased the incidence ofinfectious complications and reduced the LOSNDIof gastrointestinalpatients in this cohort study. |
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