title: Does Risk for Malnutrition in Patients Presenting With Fractures Predict Lower Quality Measures?
abstract: BACKGROUND
  The purpose of this study was to determine if nutritional screening could be used as a predictor for the development of complications and hospital readmissions.
  
  
  METHODS
  A variation of the Malnutrition Universal Screening Tool (MUST) score was collected for all inpatients with orthopaedic trauma on admission to our hospital from 2009 to 2011. We retrospectively compared each patient's MUST score with the subsequent development of infection, venous thromboembolism, respiratory failure, ulceration, or readmission. Finally, a chart review was performed to collect comorbidity data and evaluate Charlson comorbidity indexes to estimate the overall health of each patient with an available MUST.
  
  
  RESULTS
  Of the 796 consecutive patients in our total cohort, 57.7% (n = 459) were of normal nutritional status and 42.3% (n = 337) exhibited at least 1 sign of malnutrition. In patients with normal nutrition, 2.8% developed at least one of the specified complications, and we observed a complication-to-patient ratio of 0.033. In patients with signs of malnutrition, 8.0% developed at least 1 complication with a complication-to-patient ratio of 0.101. This difference was significant (P = 0.001). Multivariate regression analysis demonstrated that each additional point in a patient's nutrition score corresponded to a 49.5% increase in the odds of developing a complication when controlling for other factors (odds ratio = 1.495, confidence interval = 1.120-1.997, P = 0.006). Charlson comorbidity indexes were not significantly associated with total complications when MUST scores used were a covariant.
  
  
  CONCLUSIONS
  Patients treated for fractures and dislocations with any sign of malnutrition according to the MUST score were more than twice as likely to acquire some combination of infection, venous thromboembolism, respiratory failure, or other reason for readmission than those of normal nutritional status. Increasing levels of malnourishment corresponded with increasing risk for developing complications, whereas these complications were not necessarily associated with higher comorbidity. An assessment of a fracture patient's nutritional status should be considered a factor in evaluating risks related to fracture care. The MUST score is a predictive tool. These data have important implications for hospitals whose fiscal reimbursement is dependent on the maintenance of defined quality measures.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, NYU School of Medicine, New York, NY.
authors.forename: James H
authors.initials: JH
authors.lastname: Lee
authors.forename: Lorraine H
authors.initials: LH
authors.lastname: Hutzler
authors.forename: Brandon S
authors.initials: BS
authors.lastname: Shulman
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Karia
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005592:Fracture Fixation / Q000401:mortality*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D044342:Malnutrition / Q000401:mortality*; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult