Nutritional Supplementation of Inpatients Suggest Health and Cost Benefits

Nutritional Supplementation of Inpatients Suggest Health and Cost Benefits

Malnutrition of patients in the hospitals is a serious but under-watched problem. Malnutrition may slow down the healing processes and reduce effectiveness of medications in patients. Malnourished patients also have higher risks of poor outcomes, including increased length of stay, healthcare costs, complication costs, readmission and even mortality. Thus, several research works have already been done investigating the significance of oral supplementation in inpatients. Including the recent study “Impact of Oral Nutritional Supplementation on Hospital Outcomes” published by The American Journal of Managed Care.

A growing body of evidence suggests that Oral Nutrition Supplements (ONS), which delivered both macronutrients (carbohydrates, proteins and fats) and micronutrients (vitamins and minerals), might improve outcome among inpatients. A variety of benefits have been found by different studies, however those studies suffer from limitations, including small sample sizes, narrow selection of population and possible bias. Therefore this study’s task was to reduce the previous limitations and investigate the question of significance of oral supplementation for the inpatients.

An analysis was conducted using the database that contained diagnostic and billing information during the years of 2000-2010 and contained 44.0 million adult inpatient episodes. The research team focused on 3 key outcomes of those patients: increased length of stay, the cost, and probability of 30-day readmission. Of 44.0 million episodes – 724,027 episodes were using oral nutrition supplementation. Each adult ONS episode was matched to an adult non-ONS episode, to obtain a matched sample of 1,160,088 episodes (or patients).

This study found that use of oral nutrition supplementation in 727,027episodes led to significant reduction of length of stay at the hospital (21% decrease), cost (decrease in $4,734 or 22%), and 30-day readmission (decrease 7%). These results were in agreement with previous study results. Also this study reduced the amount of limitations that previous studies contained. A few limitations remained that could affect the results: 1) the ONS episodes had about 10 years older population compare to the non-ONS (57 vs 67 y/o), 2)doctors decided who received ONS treatment, which could lead to some bias as well, 3)there was no information on what kind or the amount of supplementation given, 4)The control group was not matched to ONS-patients by the diagnosis. This is an epidemiological (observational or a snap-shot) type of study which can definitely point out some associations and make us aware of it, but it does not show causation. This study was conducted from a single database, therefore the results can’t be taken completely as the results of any clinical controlled study. In the future, some clinical studies with more comprehensive data might be helpful to answer this question for sure.

In conclusion, this study does not provide a strong basis for the hospitals to supplement all their inpatients. Yet, knowing that often times malnutrition in the hospitals is present, it could be a good idea to talk to your doctor and ask if it would be a good idea to add supplementation to your diet while you are hospitalized.

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