Flancbaum L, Brolin R E, Kirzecky M, Mast B A, Smith C E, Kenler H A, Wallis E M, Mackenzie J W
Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903.
JPEN J Parenter Enteral Nutr. 1988 Sep-Oct;12(5):473-7. doi: 10.1177/0148607188012005473.
We studied the diagnosis-related groups (DRG) impact of nutrition support on 80 consecutive cardiac surgery patients operated upon during a 6-month period. Six of 80 patients were nutritionally depleted preoperatively. Seven received postoperative supplemental nutrition, all of whom had major postoperative complications. Patients were arbitrarily placed into three outcome groups: group I consisted of seven patients who received postoperative nutrition support; group II included 38 patients who received no nutrition support and did not develop complications; Group III consisted of 35 patients who received no nutrition support but developed postoperative complications. All group I patients were length of stay (LOS) outliers. Group I patients were significantly older than groups II and III (p less than 0.0003) and had a significantly longer average length of stay (ALOS) (p less than 0.001), ALOS in SICU (p less than 0.0001) and greater incidence of both septic complications (p less than 0.02) and mortality (p less than 0.02). Nutrition support in cardiac surgery patients warrants special DRG consideration in light of the significantly increased hospitalization and resource utilization as compared with all other patients in cardiac surgery.
我们研究了营养支持对连续80例在6个月内接受心脏手术患者的诊断相关分组（DRG）的影响。80例患者中有6例术前存在营养耗竭。7例接受了术后补充营养，所有这些患者均出现了严重的术后并发症。患者被随机分为三个结果组：第一组由7例接受术后营养支持的患者组成；第二组包括38例未接受营养支持且未发生并发症的患者；第三组由35例未接受营养支持但发生术后并发症的患者组成。所有第一组患者的住院时间（LOS）均为异常值。第一组患者明显比第二组和第三组年龄大（p<0.0003），平均住院时间（ALOS）明显更长（p<0.001），在外科重症监护病房（SICU）的住院时间更长（p<0.0001），感染并发症（p<0.02）和死亡率（p<0.02）的发生率更高。鉴于与所有其他心脏手术患者相比，住院时间和资源利用率显著增加，心脏手术患者的营养支持值得在DRG中给予特殊考虑。
