Characteristics of Hospital Stays Involving Malnutrition, 2013 #210

Characteristics of Hospital Stays Involving Malnutrition, 2013 #210

AHRQ Stats: Malnutrition Hospital Stays

Nearly 2 million hospital stays involved malnutrition among adults and children in 2013, accounting for 4.5 percent of all inpatient stays. The rate of malnutrition stays was highest among African-Americans and lowest among Hispanics. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #210: Characteristics of Hospital Stays Involving Malnutrition, 2013.) 

Characteristics of Hospital Stays Involving Malnutrition, 2013 Audrey J. Weiss, Ph.D., Kathryn R. Fingar, Ph.D., M.P.H., Marguerite L. Barrett, M.S., Anne Elixhauser, Ph.D., Claudia A. Steiner, M.D., M.P.H., Peggi Guenter, Ph.D., R.N., and Mary Hise Brown, Ph.D. Introduction Undernutrition is a form of malnutrition characterized by a lack of adequate calories, protein, or other nutrients needed for tissue maintenance and repair.1 Malnutrition (undernutrition) occurs among approximately 3 percent of adult hospital inpatient stays in the United States and is associated with increased morbidity, mortality, and health care costs.2 Adult hospitalizations with a diagnosis of malnutrition have a longer length of stay, higher costs, more comorbidities, and 5 times the likelihood of death, compared with other adult hospital stays.3 Evidence suggests that early nutritional intervention may reduce complication rates, mortality, and resource use associated with malnutrition. However, many cases of malnutrition are unrecognized and untreated.4 Clinical definitions of malnutrition and the set of diagnostic codes used to identify malnutrition in hospital administrative data have varied.5 Standardizing definitions and treatment protocols for malnutrition is complicated by the fact that its etiology is heterogeneous. Malnutrition may result from chronic starvation and conditions such as anorexia, but it also may be a consequence of acute and chronic illness or injury.6,7 Using a consistent set of diagnostic criteria and understanding the diseases that are associated with malnutrition are important for recognizing and treating malnutrition, as well as tracking its incidence, prevalence, and outcomes.8 This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents national estimates on the characteristics of malnutrition reported during nonmaternal and nonneonatal hospital inpatient stays in 2013. Although malnutrition can include high caloric intake associated with overweight and obesity when defined broadly as nutritional imbalance, this Statistical Brief examines undernutrition only. Malnutrition was identified using a broad set of diagnostic codes that included the following six categories: Postsurgical nonabsorption Nutritional neglect Cachexia Protein-calorie malnutrition Weight loss or failure to thrive Underweight This Statistical Brief presents the frequency of occurrence of the six types of malnutrition. Patient-level characteristics, admission and discharge characteristics, and outcomes for malnutrition-related stays are provided by malnutrition type. Finally, the most common primary conditions and specific principal diagnoses are presented for the different types of malnutrition-related stays. Differences in estimates of 10 percent or greater are noted in the text. Findings Hospital stays involving malnutrition, 2013 Figure 1 provides the distribution of six types of malnutrition among hospital inpatient stays in 2013.

Highlights In 2013, there were nearly 2 million hospital inpatient stays involving malnutrition. The most common type was protein-calorie malnutrition (63.9 percent of all malnutrition stays), accounting for 4.5 percent of all inpatient stays and 9.1 percent of aggregate costs (nonmaternal and nonneonatal only). Other malnutrition-related stays were for weight loss or failure to thrive (21.6 percent of all malnutrition stays), cachexia (8.3 percent), underweight (4.4 percent), postsurgical nonabsorption (1.7 percent), and nutritional neglect (0.1 percent). Patients with malnutrition tended to be older (especially 85 years or older), black, and from low income and rural areas. Compared with other types of malnutrition, in-hospital mortality was higher for stays with cachexia (11.7 percent died in the hospital) and protein-calorie malnutrition (8.4 percent)—4 to 5 times the in-hospital death rate of all nonmaternal, nonneonatal stays (2.4 percent). Average hospital costs were higher for stays involving protein-calorie malnutrition ($25,200) and postsurgical nonabsorption ($23,000) than for other malnutrition stays. Principal diagnoses varied by type of malnutrition: medical, surgical, or device complications were common for postsurgical nonabsorption; injuries and conditions due to external causes were common for nutritional neglect. Septicemia was common among all types of malnutrition.

Figure 1. Types of malnutrition among hospital stays with malnutrition, 2013 *Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample (NIS), 2013