Early and sufficient feeding reduces length of stay and charges in surgical patients

Background. The role of perioperative nutrition in surgical patients remain s controversial. We performed a Clinical Practice Improvement (CPI) study t hat, while controlling for severity of illness, explored the relationship b etween the timing and amount of parenteral or enteral nutrition, with two o utcomes: length of stay (LOS) and total charges in patients undergoing open intestinal operations. Materials and methods. A CPI study was conducted at eight hospitals to dete rmine which process steps were associated with shorter LOS and lower charge s. Hospital charts were abstracted for over 800 components of detailed pati ent, process, and outcome measures. Severity of illness was measured multip le times during the stay using the Comprehensive Severity Index, a disease- specific physiologic severity measurement instrument. Data on 1007 patients undergoing intestinal operations, 183 of whom received nutritional support , were then analyzed using multiple regression procedures. Early (within 48 h of surgery) and sufficient (60% of protein and calorie goals) nutrition, patient variables, and a severity of illness measure were included as inde pendent variables and LOS and hospital charges were used as dependent varia bles. Results. Mean patient age was 58 years. After controlling for severity of i llness, patients who received early and sufficient nutrition had significan tly shorter LOS (11.9 days) and lower charges ($34,602) than patients who r eceived early (13.3; $36,452), sufficient (14.6, $39,883), or neither early nor sufficient (14.8, $38,578) (P less than or equal to 0.0001 for early a nd sufficient versus all other groups). Conclusions. CPI methodology provides a detailed view of the actual relatio nship between the timing and the amount of nutrition with LOS and hospital charge outcomes. (C) 2001 Academic Press.