CAPER Unit Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.
Duke Clinical Research Institute, Durham, North Carolina, USA.
JPEN J Parenter Enteral Nutr. 2021 Mar;45(3):596-606. doi: 10.1002/jpen.1862. Epub 2020 Jun 3.
Postoperative nutrition delivery is essential to surgical recovery; unfortunately, postoperative dietary intake is often poor. Recent surgical guidelines recommend use of oral nutritional supplements (ONS) to improve nutrition delivery. Our aim was to examine prevalence of coded ONS use over time and coded malnutrition rates in postoperative patients.
The Premier Healthcare Database (PHD) was queried for postoperative patients found to have charges for ONS between 2008-2014. ONS use identified via charge codes. Descriptive statistics utilized to examine prevalence of malnutrition and ONS utilization. Multilevel, multivariable logistic regression models were fit to examine factors associated with ONS use.
A total of 2,823,532 surgical encounters were identified in PHD in 172 hospitals utilizing ONS charge codes. ONS-receiving patients were 72% Caucasian, 65% Medicare patients with mean age of 66 ± 16.5 years. Compared with patients not receiving ONS, ONS patients had higher van Walraven severity scores (7.3 ± 7.8 vs 2.3 ± 5.6, P < .001) with greater comorbidities. Overall coded malnutrition prevalence was 4.3%. Coded malnutrition diagnosis increased from 4.4% to 5.2% during study period. Only 15% of malnourished patients received ONS. Individual hospital practice explained much of variation in early postoperative ONS use.
In this large surgical population, inpatient ONS use is most common in older, Caucasian, Medicare patients with high comorbidity burden. Despite increased malnutrition during study period, observed ONS prescription rate did not increase. Our data indicate current ONS utilization in surgical patients, even coded with malnutrition, is limited and is a critical perioperative quality improvement opportunity.
术后营养供给对手术恢复至关重要；然而，术后饮食摄入往往不佳。最近的外科指南建议使用口服营养补充剂（ONS）来改善营养供给。我们的目的是研究ONS 使用的流行趋势和术后患者的营养不良发生率。
使用 Premier Healthcare Database（PHD）查询 2008 年至 2014 年间有 ONS 费用的术后患者。ONS 使用通过费用代码确定。使用描述性统计来检查营养不良和 ONS 使用的流行率。采用多水平、多变量逻辑回归模型来研究与 ONS 使用相关的因素。
在利用 ONS 收费代码的 172 家医院的 PHD 中，共确定了 2823532 例手术。ONS 接受者 72%为白种人，65%为医疗保险患者，平均年龄为 66 ± 16.5 岁。与未接受 ONS 的患者相比，ONS 患者的 van Walraven 严重程度评分更高（7.3 ± 7.8 与 2.3 ± 5.6，P <.001），合并症更多。总体编码营养不良的发生率为 4.3%。研究期间，编码营养不良的诊断率从 4.4%增加到 5.2%。只有 15%营养不良的患者接受了 ONS。个别医院的实践解释了术后早期 ONS 使用差异的大部分原因。
在这个大型手术人群中，ONS 最常用于年龄较大、白种人、合并症负担重的医疗保险患者。尽管研究期间营养不良增加，但观察到的 ONS 处方率并没有增加。我们的数据表明，即使在编码营养不良的情况下，ONS 在外科患者中的使用也很有限，这是一个关键的围手术期质量改进机会。
