Effect of Nutrition Intervention on Length of Hospital Stay in Severely Obese Elderly Patients

Abstract

Data were collected at 11 acute care facilities for analysis of the relationship between LOS and nutritional status in Medicare patients (≥65y) admitted with diagnoses of pneumonia, lung disease, heart failure and hip fracture. The purpose of the study was to compare the effectiveness of nutrition intervention on LOS in patients assessed at four levels of nutritional risk: 1) at-risk (R), 2) potential risk (PR), 3) severe obesity (O) and 4) not at risk (NR). A total of 562 patients with DRG admission codes 88, 89, 127 and 210 were included in the study Patients were identified at PR if one of the following criteria was present: albumin >2.5g/dl but <3.5, % IBW=80-90. R criteria included one or more of the following: albumin <2.5 g/dl, % IBW<80 or, % IBW=80-90 plus albumin >2.5 g/dl but <3.4. Patients were classified as obese if % IBW>130. Nutrition intervention consisted primarily of oral supplements and snacks, but also included some enteral and parenteral nutrition support. 20% (n=163) of patients were identified at R, 38% (n=219) were identified at PR and 13% were identified as O (n=73). Mean LOS for R patients in the intervention group (n=137) was 8.1 d; this was significantly shorter (p<.05) than R patients (n=26) nutrition intervention (10.5 d). In PR patients, mean LOS, 7.8d, for patients receiving nutrition intervention (n=158) compared to 8.2d without nutrition intervention (n=56) was not significantly different. In O patients, mean LOS in patients receiving nutrition intervention (n=60) was 7.5 days and significantly shorter(p<.05) than O patients not receiving nutrition intervention (n=13,10.6d). Mean LOS was significantly shorter (p<0.05) for adequately nourished patients (5.6d) compared to all R (8.5d), PR (7.9d) and O (8.0d). The results agree with previous reports, that severely obese patients are at risk for longer LOS and poor hospital outcome and demonstrate that nutrition intervention has an impact on LOS in obese patients equal to the effect in those identified at risk for undernutrition.