Clin Nutr. 2016 Feb;35(1):144-52.

Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study.

Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, Payette H, Bernier P, Davidson B, Teterina A, Lou W.

Department of Medicine, University Health Network, University of Toronto, 585 University Avenue, 9N-973, Toronto, ON, M5G 2C4, Canada; Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada; Department of Medicine, St-Michael Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada; Réseau de Santé Vitalité Health Network, Campbelton Regional Hospitals, 189 Lily Lake Road, PO Box 880, Campbellton, NB, E3N 3H3, Canada; Department of Medicine, St-Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada; Department of Medicine, University of Alberta, Alberta Health Services, Community Services Centre, Royal Alexandra Hospital, Edmonton, AB, T5H 3V9, Canada; Facilitée de la Médecine et des Sciences de la Santé, Université de Sherbrooke, 1036 Belvedere Street, Sherbrooke, QC, J1H 4C4, Canada; Jewish General Hospital, 3755 ch Cote Ste-Catherine, Montreal, QC, H3T 1E2, Canada; Canadian Nutrition Society, 788 Avondale Avenue, Kitchener, ON, N2M 2W8, Canada; Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2C4, Canada; Dalla Lana School of Public Health University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.

BACKGROUND & AIMS: Reducing length of stay (LOS) is a priority for hospitals but patients' decline in nutritional status may have a negative impact. The aims of the study were to assess the change in nutritional status during hospitalization and determine if its decline is associated with prolonged LOS.

METHODS: This is a prospective cohort study conducted in 18 Canadian hospitals. Subjective global assessment (SGA) and weight measurements were performed at admission and discharge. Patient information was collected at admission and extracted from the chart during hospitalization. Association between LOS and changes in SGA or weight loss ≥5% was tested using multivariate Cox PH approach. Results are expressed as hazard ratios (HR) and their 95% CI.

RESULTS: 409 patients (53% male) with a LOS >7 days were analyzed. Patients' median (q1,q3) age was 68 years (58,79) and LOS was 11 days (8,17). At admission, 49% of patients were well nourished (SGA A), 37% were moderately malnourished (SGA B) and 14% were severely malnourished (SGA C). From admission to discharge, 34% remained well-nourished, 29% remained malnourished (SGA B or C), 20% deteriorated and 17% improved. Of the 409 patients, 373 had weight measurements at admission and discharge: 92 (25%) had ≥5% weight loss. Multivariate models showed that after adjusting for covariates, decline in nutritional status from SGA A to B/C or SGA B to C (HR: 0.62, CI: (0.44, 0.87); HR: 0.35, CI: (0.20, 0.62) respectively) and weight loss ≥5% (HR: 0.52; CI: 0.40, 0.69) were significantly associated with longer LOS.

CONCLUSION: In-hospital decline in nutritional status as assessed by SGA or weight loss ≥5% is associated with prolonged LOS independently of factors reflecting demographics, living accommodations and disease severity. This suggests a role for nutrition care in reducing LOS.

KEYWORDS: Hospital malnutrition; Length of stay; Nutritional decline; Nutritional status

PMID: 25660316

DOI: 10.1016/j.clnu.2015.01.009