title: Effects of malnutrition on complication rates, length of hospital stay, and revenue in elective surgical patients in the G-DRG-system.
abstract: OBJECTIVE
  Malnutrition is known to independently affect patient outcomes. The aim of this study was to investigate the prevalence of patients at risk for malnutrition in an elective surgery patient cohort and to analyze the effects of malnutrition on morbidity, mortality, and hospital length of hospital (LOS). Furthermore, we aimed to evaluate the economic effect of a diligent coding of malnutrition, as a side diagnosis, in a simulation of the German Diagnosis-Related Group system.
  
  
  METHODS
  The nutritional status of 1244 patients undergoing elective surgery was standardized on the day of admission by the Nutritional Risk Screening (NRS) 2002. To quantify the influence of malnutrition on revenue, the real DRGs of all patients were grouped. In simulation, an appropriate International Classification of Diseases code was used as a secondary diagnosis for all malnourished patients based on the NRS rating. A multivariate logistic regression analysis and a Cox regression were performed to identify potential confounders and to determine the adjusted effect of nutritional status on the occurrence of complications and hospital LOS.
  
  
  RESULTS
  The prevalence of patients at risk for malnutrition (NRS ≥3) was 24.1% (300 of 1244). These patients showed a significant increase in hospital LOS (13 versus 7 d). Additionally, postoperative complications were significantly higher in this group (7.23% versus 6.91%). Including malnutrition in the Diagnosis-Related Group coding system resulted in a reimbursement of €1979.67 per patient at risk for malnutrition and a total reimbursement of €79,186.73 for all patients at risk for malnutrition in the present study.
  
  
  CONCLUSIONS
  Establishment of a structured, comprehensive assessment of the nutritional status of hospitalized patients can repetitiously identify patients at risk for malnutrition. Additionally, the diligent codification of malnutrition can lead to cost compensation in the German Diagnosis-Related Group system.
authors.affiliation: Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, München, Bavaria, Germany. Electronic address: Michael.Thomas@med.uni-muenchen.de.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Thomas
authors.affiliation: Apotheke, Klinikum der Universität München, München, Bavaria, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kufeldt
authors.affiliation: Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Campus Großhadern, Klinikum der Universität München, München, Bavaria, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kisser
authors.affiliation: Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, München, Bavaria, Germany.
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Hornung
authors.affiliation: Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, München, Bavaria, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Hoffmann
authors.affiliation: Apotheke, Klinikum der Universität München, München, Bavaria, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Andraschko
authors.affiliation: Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, München, Bavaria, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, München, Bavaria, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rittler
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
keywords: Hospital costs; Length of stay; Malnutrition; Nutrition; Nutritional risk