AHRQ Stats: Readmissions for Malnutrition
In 2013, the 30-day hospital readmission rate for patients with malnutrition was 23 per 100 initial hospital stays, compared with 15 per 100 for patients without malnutrition. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #218: All-Cause Readmissions Following Hospital Stays for Patients With Malnutrition, 2013.)
Kathryn R. Fingar, Ph.D., M.P.H., Audrey J. Weiss, Ph.D., 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.
Recent estimates indicate that 7 percent of nonmaternal and nonneonatal hospital stays in the United States are for patients with malnutrition,1 defined here as undernutrition characterized by lack of adequate calories, protein, or other nutrients needed for tissue maintenance and repair.2 Malnutrition has been associated with longer and more costly hospitals stays, as well as a greater likelihood of comorbidity and death among hospitalized patients.3 Conceptually, malnutrition may also contribute to posthospital syndrome, described as "an acquired, transient period of vulnerability" following hospitalization,4 which may dramatically increase risk of readmission.5,6
There are many causes of malnutrition.7,8 Some cases involve chronic starvation related to conditions such as anorexia nervosa. In other instances, malnutrition may be a consequence of an acute or chronic illness or injury, such as burns or cancer. This heterogeneity has complicated recognition and proper treatment of malnutrition in hospital-based settings, as well as efforts to develop a standard definition of malnutrition for clinical and surveillance purposes.9,10
Inpatient outcomes—including length of hospital stay, costs, and mortality—appear to vary by malnutrition type. In the United States in 2013, the in-hospital death rate was 12 percent for stays involving cachexia (i.e., wasting syndrome) and 8 percent for those involving protein-calorie malnutrition, compared with 2-5 percent for stays with other types of malnutrition, including postsurgical nonabsorption, nutritional neglect, weight loss or failure to thrive, and underweight diagnoses.11 Compared with other types of malnutrition, hospital stays involving protein-calorie malnutrition had the longest average length of stay and the highest average cost per stay.12
The frequency of readmissions following hospital stays involving malnutrition is largely unknown at a national level. Patients with malnutrition have been found to have a higher likelihood of readmission, but many studies have been conducted in other countries13,14,15or were limited to older adults,16,17 individual hospitals,18,19 or certain clinical populations.20 More research on the epidemiology of readmissions following hospital stays for patients with malnutrition is warranted.
This Healthcare Cost and Utilization Project (HCUP) Statistical Brief supplements a recent HCUP Statistical Brief that describes inpatient hospital stays among patients with six types of malnutrition: postsurgical nonabsorption, nutritional neglect, cachexia, protein-calorie malnutrition, weight loss or failure to thrive, and underweight.21 The current Statistical Brief presents additional information on the all-cause 30-day rate of readmissions following an initial inpatient hospital stay for patients with malnutrition in the United States in 2013, following the same typology of malnutrition presented in the earlier Statistical Brief.
Malnutrition was identified at the initial inpatient stay, or index stay, as either a principal or secondary diagnosis. Analysis was limited to patients with a nonmaternal and nonneonatal index stay. A patient can have multiple index stays during the course of a year. Readmissions could be for any cause; thus, malnutrition may or may not have been recorded at the time of readmission. Thirty-day readmission rates are presented for the six types of malnutrition and across patient characteristics. For comparison, the readmission rate for nonmaternal and nonneonatal index stays among patients without malnutrition also is presented. Finally, costs and reasons for readmissions are presented by presence and type of malnutrition. All differences between estimates noted in the text are greater than 10 percent.
Readmission rate by malnutrition type, 2013
Figure 1 displays the all-cause 30-day rate of readmission among patients with malnutrition following an index stay in 2013, according to type of malnutrition. For comparison, the readmission rate among patients without malnutrition at the index stay also is shown.
Figure 1. All-cause 30-day readmission rate by presence and type of malnutrition, 2013
Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Readmissions Database (NRD), 2013