Impact of a randomized, controlled trial of liberal vs conservative hospital discharge criteria on energy, protein, and fluid intake in patients who received marrow transplants

Object To determine if adult patients who received marrow transplants had f aster resumption of oral energy and nutrient intake and shorter duration of intravenous (IV) fluid requirement if discharged from the hospital earlier than is customary. Design Randomized, controlled trial of patients remaining hospitalized beca use of inadequate oral intake. Consenting patients were assigned randomly t o remain hospitalized (hospital group) or be discharged to an ambulatory se tting (ambulatory group). Subjects Seventy-eight patients of the Fred Hutchinson Cancer Research Cent er who were consuming less than 33% of estimated energy requirement and req uiring up to 3,000 mL of fluids per day intravenously. Intervention Participants received nutrition counseling by a registered die titian to promote resumption of oral intake. Daily oral intake records were analyzed to determine energy and nutrient content. Main outcome measures Days after study enrollment to consume 33% of energy and protein requirements and total number of days of IV fluid support were analyzed by group until discharge from the center, approximately 100 days a fter transplantation. Statistical analyses Demographic data were defined by group means. Differen ces between treatment procedures were determined by Cox regression analysis . No variables were confounding. Results The hospital group took fewer days than the ambulatory group to res ume oral energy intake (4.5 vs 8.0, P=.004) and to discontinue IV fluids (3 0.5 vs 48.5, P=.019). There was no difference between groups in days of par enteral nutrition support (P=.817) or days to resume oral protein intake (P =.470). Applications/conclusions Oral and gastrointestinal complications delay resu mption of oral energy and protein intakes after transplantation. Earlier ho spital discharge can achieve cost savings but may delay resumption of oral energy intake. Because of continued high-risk nutrition status and potentia l for rapid change in medical status, nutrition assessment and counseling a re necessary in both the hospital and ambulatory setting to promote resumpt ion of oral intake and discontinuation of IV fluids. J Am Diet Assoc. 2000; 100:1015-1022.