Melchior JC, Preaud E, Carles J, Brami M, Duru G, Fontaine E, Hébuterne X, Lukacs B, Zazzo JF, Panis Y, Nitenberg G. Clinical and economic impact of malnutrition per se on the postoperative course of colorectal cancer patients. Clin Nutr. 2012;31(6):896-902.
Background & Aims. To assess the medico-economic impact of malnutrition in patients who underwent surgery for colorectal cancer.
Methods. We performed post-hoc analyses of data from the Alves et al. prospective study. Using standard criteria of malnutrition, 2 groups were created a posteriori: Well-nourished (WN) and Mal-nourished (MN) patients. The 2 groups were statistically adjusted for age, cancer status, and scheduled surgery. Individual costs were valued using the French National Cost Study. Postoperative morbidity, mortality, hospital length-of-stay (LOS), and discharge setting were compared. We defined 3 scenarios, the most accurate estimate and its upper and lower limits, to assess the economic impact of malnutrition.
Results. 453 patients were included in the analyses. Complication and mortality rates were not significantly different between the 2 groups. MN patients had a mean LOS 3.41 days significantly longer than WN patients (p = 0.017). In MN patients, the cost of hospital stay was increased by around 3360 €, creating an annual impact of 10,159,436 € for French non-profit hospitals.
Conclusions. Malnutrition in colorectal cancer surgical patients is associated with an increased LOS resulting in significant budget impact. Further studies are needed to investigate this impact and the related cost-benefit of perioperative specialized nutritional support and implementation of the ERAS protocol in this homogeneous category of patients.