Mortality After Discharge in Non-cardiac Vascular Surgery Patients is Negatively Influenced by Malnutrition Measured at Hospital Discharge, Especially in Patients with Protein-Energy Malnutrition

Abstract

Introduction: Vascular surgery patients have high rates of malnutrition during hospital admission. The effects of this nutrition status on morbidity and mortality in this population, especially after hospital discharge is not well documented. We sought to determine the impact of nutrition status on out-of-hospital mortality in vascular surgery patients. Methods: We performed an observational cohort study of non-cardiac vascular surgery patients surviving hospital admission 18 years or older treated in a tertiary care hospital. The exposure of interest was malnutrition categorized as nonspecific malnutrition, protein-energy malnutrition, or well nourished. This was determined by data related to anthropometric measurements, biochemical indicators, clinical signs of malnutrition, malnutrition risk factors, and metabolic stress. The primary outcome was all cause 90 day mortality after hospital discharge. Adjusted odds ratios were estimated by multivariable logistic regression models. Results: This cohort included 5561 patients (male 53%; mean age 60.1±17.2). The re-admission rate within 30 days was 13% and the mean length of stay was 6 days (IQR 2-13). After evaluation by a dietitian 4155 patients were well nourished, 475 patients were at-risk for malnutrition, 821 had non-specific malnutrition and 110 patients had protein-energy malnutrition. The unadjusted association between nutrition status and 90-day post-discharge mortality for patients with risk of malnutrition was 2.87 (95%CI 2.14,3.85); for non-specific malnutrition OR 4.41 (95%CI 3.54-5.49) and for protein-energy malnutrition OR 7.96 (95%CI 5.20-12.20), all relative to patients without malnutrition. After adjustment for age, gender, medical versus surgical patient type, type of vascular surgery, Deyo-Charlson index and length of stay, the 90-day post-discharge mortality odds ratio for patients with risk of malnutrition was 2.22 (95%CI, 1.61-3.06); for non-specific malnutrition OR 3.01 (95%CI 2.34-3.88) and for protein-energy malnutrition OR 3.53 (95%CI 2.22-5.63), all relative to patients without malnutrition. Conclusion: Nutrition status is a reliable indicator for out-of-hospital mortality. Intensified in-hospital and out-of-hospital dietary guidance and interventions could potentially improve the prognosis of patients after vascular surgery or endovascular intervention in the future. Disclosure: Nothing to disclose