Summary

A Clinical Practice Improvement study was conducted at eight West Coast hospitals to determine areas of significant improvement in the management of abdominal surgery patients.  Data were collected on over 1,000 patients, and extensive multivariate analyses were performed.  Results show that after controlling for disease severity, patients with parenteral or enteral feeding that occurred within 48 hours of surgery and met at least 60% of the patient's protein and calorie goals had lower lengths of stay and hospital costs.

Primary Objectives

1.  Improve measurable customer value by optimizing clinical outcomes, service, and price with respect to nutritional support in adult abdominal surgery.

2. Assess the impact and timing of nutritional interventions on clinical outcomes.

3. Create optimal treatment research-based dynamic protocols.

Data were collected on over 1,000 patient who were at least 18 years old.  Study hospitals included a 116-bed rural hospital, a major urban facility serving a high proportion of low-income patients, and a university teaching hospital.  Outcomes assessed included length of stay, cost, post-operative infection, complications related to nutritional interventions, and increase in severity of illness from admission (first 24 hours) to maximum during hospital stay.  Multivariate analyses were performed on all data.

Methods (continued)

The timing of nutritional interventions was examined.  Patients who received parenteral or enteral feeding within 48 hours of surgery were considered to have been fed early. The adequacy of nutritional interventions was examined. Patients with parenteral or enteral feeding that met at least 60% of their protein and calorie needs where considered to have been fed sufficiently.

Complications frequently associated with nutritional interventions were examined in all patients. The most frequent included line infections, superficial and deep wound infections, pneumonia, nausea, vomiting, diarrhea, and constipation.

Results

1.  Patients who received both early and sufficient feeding interventions had shorter lengths of stay and lower hospital costs than others receiving feeding interventions.

2.  The only feeding intervention complication found to occur significantly more often was diarrhea in enterally fed patients

Impact

Even though they had higher average severity of illness, those patients fed early and sufficiently had between 1.4 and 2.9 days shorter average length of stay and between $1,940 and $5,281 lower average cost per case than patients fed either not early and/or not sufficiently.