Nutrition Support Team, University Hospital Tuebingen, Tuebingen, Germany.
Department of Radiation Oncology, University Hospital Tuebingen, Tuebingen, Germany.
Strahlenther Onkol. 2018 Nov;194(11):1049-1059. doi: 10.1007/s00066-018-1360-9. Epub 2018 Sep 4.
The nutritional status of inpatients influences the therapeutic outcome. Malnutrition is a common comorbidity in oncological patients. Both radio- and radiochemotherapy may contribute to the additional deterioration of the nutritional status. The aim of this study was to evaluate the impact of specialized treatment of malnutrition as a clinical routine.
The nutritional status of inpatients was assessed by the Nutritional risk screening (NRS-2002) on the day of admission to the University Department of Radiation Oncology. In case of significantly elevated NRS-2002 (NRS ≥ 3), a guideline-compliant, individual nutritional treatment was initiated by a specialized nutrition support team. The influence of the nutritional status and nutritional treatment on length of stay and complication rate was assessed.
Of 840 included patients, 344 patients (40.95%) were at risk for malnutrition. Malnutrition was a significant, independent risk factor for both prolonged hospital stay, represented by the deviation between the actual length of stay and the DRG-associated mean length of stay (dLOS at risk: 0.88 days, dLOS not at risk: -0.88 days, p = 0.0047), as well as for the occurrence of complications (OR: 1.758 CI: [1.286-2.402], p = 0.0006). In the group of 337 (40.12%) rehospitalized patients the nutritional management was able to assimilate the values of length of stay as well as the complication rates to standard values.
The high risk for malnutrition and the negative consequences for patients and hospitals underline the urgent need for malnutrition screening on admission and treatment of malnutrition. A specialized, interdisciplinary nutrition support team positively influences patient outcome and should be established routinely in all oncological disciplines.
住院患者的营养状况会影响治疗效果。营养不良是肿瘤患者的常见合并症。放化疗都可能导致营养状况进一步恶化。本研究旨在评估将营养不良的专业治疗作为临床常规的影响。
在入住大学放射肿瘤学系的当天，通过营养风险筛查（NRS-2002）评估住院患者的营养状况。如果 NRS-2002 明显升高（NRS≥3），则由专门的营养支持小组根据指南开始进行个体化营养治疗。评估营养状况和营养治疗对住院时间和并发症发生率的影响。
在 840 例纳入的患者中，有 344 例（40.95%）存在营养不良风险。营养不良是住院时间延长的显著独立危险因素，表现为实际住院时间与 DRG 相关平均住院时间的偏差（风险组的 dLOS：0.88 天，非风险组的 dLOS：-0.88 天，p=0.0047），以及并发症的发生（OR：1.758 CI：[1.286-2.402]，p=0.0006）。在 337 例（40.12%）再次住院的患者中，营养管理能够使住院时间和并发症发生率的数值恢复到标准值。
营养不良风险高，对患者和医院都有负面影响，这突出表明迫切需要在入院时进行营养不良筛查并进行治疗。专门的、跨学科的营养支持小组对患者的预后有积极影响，应该在所有肿瘤学领域常规建立。
