Malnutrition in Surgical Patients

Hill, Graham L.; Pickford, I. R.; Young, Gerald A.; Schorah, C.J.; Blackett, R. L.; Burkinshaw, L.; Warren, Judith; Morgan, Diane

doi:10.1016/s0140-6736(77)92127-4

Cited by 439 publications

(150 citation statements)

References 8 publications

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“…A similar situation was also reported in subsequent years (McWhirter & Pennington, 1994) and in other European countries (Pablo et al, 2003). In some patients, malnutrition symptoms, found on admission to hospital, increased during hospitalisation (Hill et al, 1977;McWhirter & Pennington, 1994). Mc Whirter and Pennington demonstrated that almost 40% of patients admitted to a big university hospital in Great Britain had body mass index (BMI) below 20 kg/m 2 , which should be regarded as symptoms of undernutrition.…”

Section: Introductionsupporting

confidence: 62%

“…These studies were conducted mainly in the population of hospitalised persons, and it was demonstrated that a significant percentage of patients admitted to hospitals in the USA and Great Britain showed clinical or biochemical symptoms of malnutrition (Bistrian et al, 1974(Bistrian et al, , 1976Hill et al, 1977). A similar situation was also reported in subsequent years (McWhirter & Pennington, 1994) and in other European countries (Pablo et al, 2003).…”

Section: Introductionmentioning

confidence: 72%

“…Mc Whirter and Pennington demonstrated that almost 40% of patients admitted to a big university hospital in Great Britain had body mass index (BMI) below 20 kg/m 2 , which should be regarded as symptoms of undernutrition. Besides that, it was demonstrated that abnormalities were more frequent in patients who were still in hospital more than a week after major surgery (Hill et al, 1977). Malnutrition of patients increases morbidity, length of stay (Reilly et al, 1988;Waitzberg et al, 2001) and treatment cost (Christensen, 1986;Tucker & Miguel, 1996).…”

Section: Introductionmentioning

confidence: 99%

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Nutritional status of patients hospitalised in Poland

et al. 2005

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Aim: Screening and extended assessment of the nutritional status of patients on admission and on discharge from hospital were carried out. Description: The studies were carried out in four teaching hospitals, four provincial hospitals and four county hospitals in Poland. Subjects: Screening examinations were carried out for 3310 randomly selected patients (every 10th patient admitted to hospital, including 1916 female cases aged from 16 to 92 y and 1394 male patients aged from 16 to 100 y). Extended examinations were carried out on 210 patients aged from 16 to 87 y (including 122 female and 88 male). Main assessment parameters: Anthropometric (height, weight, body mass index (BMI), waist-to-hip ratio (WHR), arm circumference) and biochemical indices (erythrocyte count, haemoglobin concentration, white blood cell count, blood lymphocyte count and serum albumin serum concentration). The extended examinations included determination of antioxidant vitamins (A, C, E), vitamin B 12 and folic acid. Results: On admission to hospital, 10.43% of the patients surveyed had a BMI below 20 kg/m 2 , in 20.74% of patients serum albumin concentration was below 3.5 g/dl, indicating possible protein energy malnutrition. In addition, 21.02% had lymphocyte count below 1.5 Â 10 3 /mm 3 . During hospitalisation, deterioration in the nutritional status of the patient population occurred. On discharge from hospital, the percentage of patients with BMIo20 kg/m 2 increased to 11.21% and the percentage with low blood albumin (o3.5 g/dl) increased to 28.57%. On admission, vitamin C deficiency was present in 51.8% of patients, folic acid deficiency in 32%, vitamin E deficiency in 10%, vitamin B 12 deficiency in 6.8% and vitamin A deficiency in 1.4%. Vitamin deficiencies were present equally in malnourished, overweight and obese patients. Conclusions: In patients admitted to hospitals in Poland, malnutrition risk demonstrated by BMI was observed in 10.43% of patients. On the basis of biochemical indices, increased nutritional risk was demonstrated in 21% of patients. Vitamin malnutrition was seen in the majority of patients. A significant correlation between weight, BMI, arm circumference, blood lymphocyte count and the number of days spent in hospital was observed.

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Section: Introductionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

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Nutritional status of patients hospitalised in Poland

et al. 2005

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“…Surprisingly, the effect of preoperative nutritional status on the outcome of patients has not been reported in the literature. Indeed, the relationship between poor nutritional status and subsequent postoperative morbidity and mortality is well recognised in the surgical literature 13,14,22 .This study aims to determine the prevalence of undernutrition and its influence on outcome and hospital stay in hydrocephalus patients undergoing shunt surgery in India. In addition, we also sought to determine the nutrition parameter † Work performed…”

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confidence: 99%

The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery

et al. 2007

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Undernutrition is common in surgical patients, is frequently unrecognised and is strongly associated with adverse outcomes such as high rates of complications and mortality, worsening functional status and prolonged hospitalisation. Owing to the associated infection and symptoms such as repeated vomiting, a high prevalence of undernutrition is expected in hydrocephalus patients, which may contribute to their poor surgical outcomes. The aim of this study was to evaluate the influence of preoperative nutritional status on the outcome of Indian patients with hydrocephalus undergoing neurosurgical shunt surgery. One hundred and twenty-four consecutive patients undergoing scheduled hydrocephalus shunt surgery were studied prospectively. All patients underwent nutritional screening according to different parameters prior to surgery. The patients were classified into normally nourished and undernourished groups. The undernourished group was further subdivided into moderately and severely undernourished. The surgical outcome was compared between these groups. A high prevalence (53 %) of undernutrition was observed in these patients. Postoperative complications such as shunt infection (P¼0·0023), shunt revision (P¼ 0·0074) and mortality (P¼ 0·0003) were significantly more common in undernourished patients compared with normally nourished patients. Serum albumin emerged as the most significant independent predictor of postoperative mortality. The present study demonstrated a high prevalence of undernutrition in hydrocephalus patients in India and its adverse influence on the outcome of shunt surgery. Early preoperative nutritional status screening and its optimisation may decrease the morbidity and mortality of shunt surgery for hydrocephalus. Nutritional status: Hydrocephalus: Neurosurgical shunt surgeryThe influence of nutritional status on the course of an illness was already known to Hippocrates when he stated that well-fed patients would recover more quickly 1 . Since then, numerous studies have widely acknowledged the deleterious effects of impaired nutritional status on clinical outcome 2 -4 and hospital costs 5 . Undernutrition, however continues to be a significant problem in surgical patients, with up to 40 % of patients being undernourished on admission to hospital, and about 78 % of the undernourished patients who stay longer in hospital losing further weight 6 -8 .This deterioration of nutritional status in the patient undergoing surgery may result in reduced systemic immunity, an exaggerated stress response, organ system dysfunction, poor wound healing and delayed functional recovery 7,9 -14 . Therefore, careful preoperative nutritional assessment followed by the initiation of appropriate nutritional therapies has been proposed to improve outcomes 12 . Hydrocephalus is a clinical condition marked by the excessive accumulation of cerebrospinal fluid within the cerebral ventricles. It is more frequent in children and results from congenital or acquired disease processes including developmental anomalies, neop...

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“…Protein-energy undernutrition, or the possibility of its development, has been documented to occur frequently in surgical patients admitted to hospital (Bistrian et al 1974;Hill et al 1977;McWhirter & Pennington, 1994). Moreover, nutritional status has been shown to deteriorate over the course of the hospital stay (Weinsier et al 1979;McWhirter & Pennington, 1994;Corish et al 1998a,b), a fact not recognized by medical and nursing staff (McWhirter & Pennington, 1994;Lennard-Jones et al 1995;Reilly et al 1995).…”

Section: Undernutrition: Nutritional Screening: Nutritional Assessmentmentioning

confidence: 99%

Pre-operative nutritional assessment

Corish

1999

Proc. Nutr. Soc.

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Protein-energy undernutrition, or the possibility of its development, has been documented to occur frequently in surgical patients admitted to hospital. Nutritional status is known to deteriorate over the course of the hospital stay, with poor awareness by medical and nursing staff as to the deleterious effects of impaired nutritional status on clinical outcome and hospital costs. While there is no consensus on the best method for assessment of the nutritional status of surgical patients pre-operatively, there are a number of techniques available. These techniques can be divided into two types, those suitable for screening for nutrition risk on admission to hospital and those used to fully assess nutritional status. Both techniques have their limitations, but if used correctly, and their limitations recognized, should identify the appropriate degree of nutritional intervention for an individual patient in a timely and cost-effective manner. The techniques currently available for nutritional screening and nutritional assessment are reviewed, and their applicability to the Irish setting are discussed in the present paper.

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Malnutrition in Surgical Patients

Cited by 439 publications

References 8 publications

Nutritional status of patients hospitalised in Poland

Nutritional status of patients hospitalised in Poland

The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery

Pre-operative nutritional assessment

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