J. Sadeghi1, K. Duh1,2, R. Barerra1 1North Shore University And Long Island Jewish Medical Center,Manhasset, NY, USA, 2Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,Hempstead, NY, USA
Introduction: The timing, route, source and amount of nutrition for surgical patients with substantial caloric deficits remain active areas of study. There is benefit to starting nutrition early in surgical patients with large caloric deficits, but the data is based on in-hospital nutrition deficits and does not take into account patients’ pre-hospital courses. There has been minimal research and no guidelines set forth regarding pre-hospital nutrition deficits in surgical patients. Large pre-hospital caloric deficits with inadequate or delayed nutritional supplementation may lead to poorer outcome measures including length of stay, functional status, and 30-day readmission rates.
Methods: We performed a retrospective review of 50 surgical patients over one year admitted to two metropolitan surgical centers with a primary admitting diagnosis of small bowel obstruction, acute pancreatitis, or diverticulitis and assessed their pre-hospital and inpatient caloric deficit. Pre-hospital deficits were estimated using patient-reported days with significant nausea, emesis, and absent oral intake. Inpatient deficits were estimated using total days kept NPO. Patients were classified as either mildly malnourished (2,500-5,000 Kcal) or moderate-severely malnourish (>5,000 Kcal) and compared to patients with no pre-hospital deficit for length of stay, status on discharge as measured by ambulatory status and disposition, and 30-day readmission rate.
Results:The average lengths of stay for the no deficit group, the mild deficit group, and the moderate-severe deficit groups were 7.79, 8.14, and 14 days respectively. The rates of independent functional ambulatory status upon hospital discharge were 72.41%, 69.23%, and 62.5%. The rates of discharge home were 89.65%, 100%, and 85.71%. The 30-day readmission rates were 20.69%, 21.43%, and 42.86%.
Conclusion: Large caloric deficits lead to poorer surgical outcomes, but pre-hospital caloric deficits are not routinely studied. Based on our preliminary results, we found that >5,000 Kcal pre-hospital deficits increase hospital length of stay and 30-day readmission rates. We suggest that pre-hospital caloric deficit should be routinely considered both in determining timing of supplemental nutrition and in future study protocols examining supplemental nutrition.