Michael N Thomas1, Johannes Kufeldt2, Ulrich Kisser3, Hans-Martin Hornung4, Jessica Hoffmann4, Monika Andraschko2, Jens Werner4, Peter Rittler4. 1. Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, München, Bavaria, Germany. Electronic address: Michael.Thomas@med.uni-muenchen.de. 2. Apotheke, Klinikum der Universität München, München, Bavaria, Germany. 3. Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Campus Großhadern, Klinikum der Universität München, München, Bavaria, Germany. 4. Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, München, Bavaria, Germany.
Abstract
OBJECTIVE: Malnutrition is known to independently affect patient outcomes. The aim of this study was to investigate the prevalence of patients at risk for malnutrition in an elective surgery patient cohort and to analyze the effects of malnutrition on morbidity, mortality, and hospital length of hospital (LOS). Furthermore, we aimed to evaluate the economic effect of a diligent coding of malnutrition, as a side diagnosis, in a simulation of the German Diagnosis-Related Group system. METHODS: The nutritional status of 1244 patients undergoing elective surgery was standardized on the day of admission by the Nutritional Risk Screening (NRS) 2002. To quantify the influence of malnutrition on revenue, the real DRGs of all patients were grouped. In simulation, an appropriate International Classification of Diseases code was used as a secondary diagnosis for all malnourished patients based on the NRS rating. A multivariate logistic regression analysis and a Cox regression were performed to identify potential confounders and to determine the adjusted effect of nutritional status on the occurrence of complications and hospital LOS. RESULTS: The prevalence of patients at risk for malnutrition (NRS ≥3) was 24.1% (300 of 1244). These patients showed a significant increase in hospital LOS (13 versus 7 d). Additionally, postoperative complications were significantly higher in this group (7.23% versus 6.91%). Including malnutrition in the Diagnosis-Related Group coding system resulted in a reimbursement of €1979.67 per patient at risk for malnutrition and a total reimbursement of €79,186.73 for all patients at risk for malnutrition in the present study. CONCLUSION: Establishment of a structured, comprehensive assessment of the nutritional status of hospitalized patients can repetitiously identify patients at risk for malnutrition. Additionally, the diligent codification of malnutrition can lead to cost compensation in the German Diagnosis-Related Group system.
OBJECTIVE:Malnutrition is known to independently affect patient outcomes. The aim of this study was to investigate the prevalence of patients at risk for malnutrition in an elective surgery patient cohort and to analyze the effects of malnutrition on morbidity, mortality, and hospital length of hospital (LOS). Furthermore, we aimed to evaluate the economic effect of a diligent coding of malnutrition, as a side diagnosis, in a simulation of the German Diagnosis-Related Group system. METHODS: The nutritional status of 1244 patients undergoing elective surgery was standardized on the day of admission by the Nutritional Risk Screening (NRS) 2002. To quantify the influence of malnutrition on revenue, the real DRGs of all patients were grouped. In simulation, an appropriate International Classification of Diseases code was used as a secondary diagnosis for all malnourished patients based on the NRS rating. A multivariate logistic regression analysis and a Cox regression were performed to identify potential confounders and to determine the adjusted effect of nutritional status on the occurrence of complications and hospital LOS. RESULTS: The prevalence of patients at risk for malnutrition (NRS ≥3) was 24.1% (300 of 1244). These patients showed a significant increase in hospital LOS (13 versus 7 d). Additionally, postoperative complications were significantly higher in this group (7.23% versus 6.91%). Including malnutrition in the Diagnosis-Related Group coding system resulted in a reimbursement of €1979.67 per patient at risk for malnutrition and a total reimbursement of €79,186.73 for all patients at risk for malnutrition in the present study. CONCLUSION: Establishment of a structured, comprehensive assessment of the nutritional status of hospitalized patients can repetitiously identify patients at risk for malnutrition. Additionally, the diligent codification of malnutrition can lead to cost compensation in the German Diagnosis-Related Group system.
Authors: Pascal Probst; Juri Fuchs; Michael R Schön; Georgios Polychronidis; Christos Stravodimos; Arianeb Mehrabi; Markus K Diener; Philipp Knebel; Markus W Büchler; Katrin Hoffmann Journal: Hepatobiliary Surg Nutr Date: 2020-08 Impact factor: 7.293
Authors: U Kisser; J Kufeldt; C Adderson-Kisser; S Becker; P Baumeister; M Reiter; U Harréus; M N Thomas; P Rittler Journal: Eur Arch Otorhinolaryngol Date: 2016-03-18 Impact factor: 2.503
Authors: Shane Shahrestani; Joshua Bakhsheshian; Xiao T Chen; Andy Ton; Alexander M Ballatori; Ben A Strickland; Djani M Robertson; Zorica Buser; Raymond Hah; Patrick C Hsieh; John C Liu; Jeffrey C Wang Journal: EClinicalMedicine Date: 2021-05-15