Malnutrition in Acute Care Surgery Patients in Rwanda

Abstract

Introduction Malnutrition is prevalent in hospitalized surgical patients and has been shown to significantly alter outcomes including length of hospital stay, complications, and mortality. Different tools for nutrition assessment were developed and are being used. The aim of this study was to characterize the nutritional status of acute care surgery patients, determine risk factors for malnutrition, and describe outcomes in patients with malnutrition. Methods This was a prospective, descriptive study of malnutrition in acute care surgery patients at CHUK. Over a 6-month time period, we collected data on demographics, diagnosis, operation, and patient outcomes. We assessed the incidence of malnutrition using the American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines and Subjective Global Assessment (SGA). We reported frequencies and percentages for categorical variables and median and interquartile range (IQR) for continuous variables. ResultsWe analyzed data for 279 acute care surgery patients. Most (n = 209, 73%) patients were male. The median duration of symptoms was 5 days (IQR 2, 14). The most common diagnoses were trauma (n = 83, 30%), intestinal obstruction (n = 76, 27%), and peritonitis (n = 49, 18%). Most (n = 210, 73%) patients underwent operation. The median length of hospital stay was 6 days (IQR 4,11). Using ASPEN guidelines, 99 (35%) patients had evidence of malnutrition on hospital admission and 76 (27%) had evidence of malnutrition using SGA. After 1 week of hospital stay, 48 (41%) patients had evidence of malnutrition. Overall mortality was 3%, with higher mortality seen in patients with malnutrition (8% vs. 0.6%, p = 0.001). The length of hospital stay was longer in patients with malnutrition on hospital admission (6 days vs. 5 days, p = 0.044). Conclusions Acute care surgical patients present to the hospital at high-risk for malnutrition. Efforts are needed to ensure that surgical patients receive adequate nutrition support to improve patient outcomes and minimize complications.

Concurrent and Predictive Validity of AND‐ASPEN Malnutrition Consensus Is Satisfactory in Hospitalized Patients: A Longitudinal Study

“…In a recent Brazilian prospective study involving 414 critically ill trauma patients, Ceniccola et al (2020) also demonstrated satisfactory accuracy (area under the curve [AUC] = 0.78; 95% CI, 0.72–0.83), with moderate sensitivity (89.2%), low specificity (66.4%), and a κ coefficient equal to 0.570 16 . Likewise, recently, Abahuje et al (2020) showed a satisfactory accuracy of AND‐ASPEN to identify malnutrition (AUC = 0.75; CI not reported), but also a moderate κ coefficient value (0.529) 17 . The lower agreement between SGA and AND‐ASPEN indicated in the previously cited studies, in comparison with our results, can possibly be explained by the sample, which was composed of acute care patients.…”

“…The large CI for in‐hospital mortality and for 6‐month mortality suggests an imprecise result, which possibly may be explained by the low incidence of death in the sample, in both cases. About 10 studies have been published regarding the evaluation of the predictive validity of the AND‐ASPEN Consensus 16‐19,21‐26,40 . A prospective longitudinal study carried out with 490 oncological and surgical patients from a US hospital described that malnutrition defined by AND‐ASPEN was a predictor of prolonged LOS (odds ratio, 1.67; without description of 95% CI) 21 .…”

“…Considering the difficulty of the HGS measure in clinical practice, in the current study the accuracy of AND‐ASPEN while omitting HGS was also tested, and this adapted version presented satisfactory concurrent and predictive validity. Among the studies about the AND‐ASPEN Consensus, more than half of them did not perform the HGS measure and applied this malnutrition consensus while omitting functional status 15‐18,21‐24,26 . Also, 1 of them used the self‐reported diminished functional status as a substitute for HGS for diagnosis by the AND‐ASPEN 22 .…”

“…In a literature search, 4 studies were identified that aimed to evaluate the concurrent validity of the AND‐ASPEN Consensus in hospitalized patients, considering the SGA as the reference method, 15‐18 and all of them demonstrated satisfactory accuracy (>75%) and moderate to substantial agreement between the tools. In addition, according to the available literature about AND‐ASPEN, this tool is also able to predict satisfactory clinical outcomes 16,17,19‐26 . Recent studies have also explored the concurrent validity of the GLIM criteria vs SGA, 18,27 as well as its predictive validity, 28‐32 with satisfactory results being demonstrated.…”

Consensus on the standard terminology used in the nutrition care of adult patients with chronic kidney disease

“…Studies reported satisfactory levels of accuracy and moderate agreement for the MCC compared to the SGA in adult hospitalized patients 94 , individuals with severe conditions in general, trauma 95 , and surgery patients 96 . In regard to outcomes, the MCC predicted longer hospitalization times 97 and higher care costs 98 .…”