Undernutrition in adult hospitalized patients and its impact on the length of stay, a 10-year repeated cross-sectional study analyzing 65,226 stays

Abstract

Background & aims

The prevalence of undernutrition in hospitalized patients and its impact on their length of stay (LOS) varies considerably depending on the population studied, the diagnosis criteria or the screening tools used. Previous reports using controlled data have been done on small populations while large cohorts have been studied on unverified declarative data. This study aims at determining the prevalence of undernutrition in a large population using verified anthropometric data and assessing its impact on the LOS.

Methods

– For 10 years (2007–2017), a specialized nutritional assessment unit screened inpatients in a tertiary hospital for undernutrition, with the exception of those in emergency and intensive care, orthopedics, pediatrics and maternity wards. Within each unit, screening was carried out every two to three weeks. The diagnosis of undernutrition in adult inpatients was made using body mass index (BMI) (<18.5 kg/m² for age <70 or < 21 kg/m² for age ≥70) or weight loss (weight loss >5 % over a month or >10 % over 6 months). We retrospectively analyzed this database, looking at all adults (>18 years) hospitalized for at least one day. The analysis of the prevalence of undernutrition and its consequence on the LOS was performed on the entire population as well as by sex, age groups and diagnosis-related groups (DRGs). Statistics were performed using the chi-square test, T-test, ANOVA and mixed linear analysis. Age and gender were added as potential confounders, while DRG was included as a random effect.

Results

The analysis included data from 65,226 stays. Mean age 65 years (min 18, max 113), 58.2 % male patients. The overall prevalence of undernutrition was 29.77 %, lower in the 40 to 70-year-old group than in the younger and older population. Undernutrition was present in all of the 53 surveyed DRGs, with a prevalence ranging from 12 % to 57.89 %. In the overall population, undernourished patients had a longer LOS than well-nourished patients, with a median increase of 5 days. In 42 of the 53 DRGs, representing 97.57 % of the total population, undernutrition significantly increased the LOS.

Conclusions

This large study of the prevalence of undernutrition diagnosed from verified anthropometric data in hospitalized adults does not confirm recent findings obtained from unverified data in hospital databases.