title: Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality.
abstract: OBJECTIVE
  The confounding effect of disease on the outcomes of malnutrition using diagnosis-related groups (DRG) has never been studied in a multidisciplinary setting. This study aims to determine the prevalence of malnutrition in a tertiary hospital in Singapore and its impact on hospitalization outcomes and costs, controlling for DRG.
  
  
  METHODS
  This prospective cohort study included a matched case control study. Subjective Global Assessment was used to assess the nutritional status on admission of 818 adults. Hospitalization outcomes over 3 years were adjusted for gender, age, ethnicity, and matched for DRG.
  
  
  RESULTS
  Malnourished patients (29%) had longer hospital stays (6.9±7.3 days vs. 4.6±5.6 days, p<0.001) and were more likely to be readmitted within 15 days (adjusted relative risk=1.9, 95% CI 1.1-3.2, p=0.025). Within a DRG, the mean difference between actual cost of hospitalization and the average cost for malnourished patients was greater than well-nourished patients (p=0.014). Mortality was higher in malnourished patients at 1 year (34% vs. 4.1 %), 2 years (42.6% vs. 6.7%) and 3 years (48.5% vs. 9.9%); p<0.001 for all. Overall, malnutrition was a significant predictor of mortality (adjusted hazard ratio=4.4, 95% CI 3.3-6.0, p<0.001).
  
  
  CONCLUSIONS
  Malnutrition was evident in up to one third of the inpatients and led to poor hospitalization outcomes and survival as well as increased costs of care, even after matching for DRG. Strategies to prevent and treat malnutrition in the hospital and post-discharge are needed.
authors: Dietetics Department, National University Hospital, 5 Lower Kent Ridge Road, Main Building, Singapore 119074, Singapore. su_lin_lim@nuhs.edu.sg
authors: Su Lin
authors: SL
authors: Lim
authors: Kian Chung Benjamin
authors: KC
authors: Ong
authors: Yiong Huak
authors: YH
authors: Chan
authors: Wai Chiong
authors: WC
authors: Loke
authors: Maree
authors: M
authors: Ferguson
authors: Lynne
authors: L
authors: Daniels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D044342:Malnutrition / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D009026:Mortality; D010359:Patient Readmission / Q000191:economics; D015995:Prevalence; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology; D055815:Young Adult