Linn B S, Robinson D S
Education Service, Veterans Administration Medical Center, Miami, FL 33125.
JAMA. 1988;260(4):514-8.
Our purpose was to determine if the introduction of prospective payment according to diagnosis related groups (DRGs) was associated with any adverse effect on the nutritional status of patients undergoing massive resections for head and neck cancer. The hypothesis was that malnourished patients, in particular those admitted since prospective payment was instituted, would be less well nourished at the time of surgery due to shortened preoperative stays, and, therefore, they would have more postoperative complications than malnourished patients admitted before DRGs. We compared 59 male patients with cancer of the head and neck admitted for massive resections before the introduction of DRGs with 61 similar patients admitted after the introduction of DRGs. These patients were classified as being either malnourished or well nourished. Nutritional status did not differ significantly at admission but was worse at surgery after the introduction of DRGs. In malnourished patients, complication scores were over two times higher after the introduction of DRGs. We conclude that malnourished patients have not fared as well since the prospective payment system was introduced and that other ways need to be devised so malnourished patients can be treated, such as adjusting DRG payments or providing preadmission nutritional support.
