title: Clinical and economic impact of malnutrition per se on the postoperative course of colorectal cancer patients.
abstract: OBJECTIVE
  To assess the medico-economic impact of malnutrition in patients who underwent surgery for colorectal cancer.
  
  
  METHODS
  We performed post-hoc analyses of data from the Alves et al. prospective study. Using standard criteria of malnutrition, 2 groups were created a posteriori: Well-nourished (WN) and Mal-nourished (MN) patients. The 2 groups were statistically adjusted for age, cancer status, and scheduled surgery. Individual costs were valued using the French National Cost Study. Postoperative morbidity, mortality, hospital length-of-stay (LOS), and discharge setting were compared. We defined 3 scenarios, the most accurate estimate and its upper and lower limits, to assess the economic impact of malnutrition.
  
  
  RESULTS
  453 patients were included in the analyses. Complication and mortality rates were not significantly different between the 2 groups. MN patients had a mean LOS 3.41 days significantly longer than WN patients (p = 0.017). In MN patients, the cost of hospital stay was increased by around 3360 €, creating an annual impact of 10,159,436 € for French non-profit hospitals.
  
  
  CONCLUSIONS
  Malnutrition in colorectal cancer surgical patients is associated with an increased LOS resulting in significant budget impact. Further studies are needed to investigate this impact and the related cost-benefit of perioperative specialized nutritional support and implementation of the ERAS protocol in this homogeneous category of patients.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Melchior
authors.affiliation: Acute Medicine Department, R. Poincaré Hospital, APHP, Garches, Versailles Saint-Quentin-en-Yvelines University, Medical School, EA 4497, France. jean-claude.melchior@rpc.aphp.fr
authors.forename: Melchior
authors.initials: M
authors.lastname: Jean-Claude
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Préaud
authors.forename: Préaud
authors.initials: P
authors.lastname: Emmanuelle
authors.forename: Juliette
authors.initials: J
authors.lastname: Carles
authors.forename: Heurtebis
authors.initials: H
authors.lastname: Juliette
authors.forename: Michèle
authors.initials: M
authors.lastname: Brami
authors.forename: Brami
authors.initials: B
authors.lastname: Michèle
authors.forename: Gérard
authors.initials: G
authors.lastname: Duru
authors.forename: Duru
authors.initials: D
authors.lastname: Gérard
authors.forename: Eric
authors.initials: E
authors.lastname: Fontaine
authors.forename: Fontaine
authors.initials: F
authors.lastname: Eric
authors.forename: Xavier
authors.initials: X
authors.lastname: Hébuterne
authors.forename: Hébuterne
authors.initials: H
authors.lastname: Xavier
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lukacs
authors.forename: Lukacs
authors.initials: L
authors.lastname: Bertrand
authors.forename: Jean-Fabien
authors.initials: JF
authors.lastname: Zazzo
authors.forename: Zazzo
authors.initials: Z
authors.lastname: Jean-Fabien
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
authors.forename: Panis
authors.initials: P
authors.lastname: Yves
authors.forename: Gérard
authors.initials: G
authors.lastname: Nitenberg
authors.forename: Nitenberg
authors.initials: N
authors.lastname: Gérard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000191:economics* / Q000401:mortality / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D044342:Malnutrition / Q000191:economics* / Q000628:therapy; D008875:Middle Aged; D009752:Nutritional Status; D010351:Patient Discharge / Q000191:economics; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome