Fatores associados ao risco nutricional e desfechos clínicos em pacientes cirúrgicos não-oncológicos de um hospital universitário no nordeste brasileiro

Jaíne Teixeira  Bezerra; Nathaly Esperidião  de Melo; Patrícia Brazil Pereira  Coelho; Celina de Azevedo Dias; Maria Izabel Siqueira  de Andrade; Janatar Stella Vasconcelos de Melo Me Mpomo

doi:10.12873/413bezerra

Authors

Jaíne Teixeira Bezerra
Nathaly Esperidião de Melo
Patrícia Brazil Pereira Coelho
Celina de Azevedo Dias
Maria Izabel Siqueira de Andrade
Janatar

DOI:

https://doi.org/10.12873/413bezerra

Keywords:

Triage, General Surgery, Malnutrition, Postoperative Period

Abstract

Objective: Identify nutritional risk, associated factors and clinical outcomes in non-oncological surgical patients.

Methods: A retrospective observational study was conducted using records available on patient charts. Data were collected from non-oncological surgical patients 20 years of age or older hospitalized at a university hospital in Alagoas, Brazil, between October and December 2019. The patients were classified regarding nutritional risk using the Nutritional Risk Screening-2002 tool. The exploratory variables were type, severity, and temporal classification of surgery, total hospital stay, postoperative hospital stay and clinical outcome. The level of statistical significance was set at 5% (p <0.05).

Results: One hundred thirteen patients were evaluated; 66.4% were women and mean age was 48.1±14.5 years. Nutritional risk was identified in 11.5% of the sample. Individuals without risk had a greater frequency of excess weight (64% versus 30.8%) (p <0.04). Older people had a greater frequency of nutritional risk compared to adults (61.54% versus 38.46%; p = 0.002). Patients with nutritional risk were submitted to major surgery more often (70%), followed by minor surgery (20%) and surgery of moderate severity (10%) (p = 0.007). The classification of risk determined a longer postoperative hospital stay, with an average of three additional days (p = 0.022). Death occurred in 15.4% of the individuals at nutritional risk (p = 0.035).

References

Correia MITD, Perman MI, Waitzberg DL. Hospital malnutrition in Latin America: a systematic review. Clin Nutr. 2017;36(4):958-67. DOI: https://doi.org/10.1016/j.clnu.2016.06.025

Giroldi M, Boscaini C. Nutritional and biochemical profile of hospitalized patients in use of enteral nutrition therapy. Rev Nutr. Clin 2016;31(1): 65-9.

Correia MI, Hegazi RA, Diaz-pizarro Graf JI; Gomez-morales G, Fuentes gutiérrez C, Goldin MF, et al. Addressing disease-related malnutrition in healthcare: A Latin American perspective. JPEN J Parenter Enteral Nutr. 2016;40(3):319-25. DOI: https://doi.org/10.1177/0148607115581373

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin nutr. 2003;22(3):321-36. DOI: https://doi.org/10.1016/S0261-5614(02)00214-5

Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin nutr. 2003;22(4):415-21. DOI: https://doi.org/10.1016/S0261-5614(03)00098-0

NUNES, Patrícia Pereira; MARSHALL, Norma Guimarães. Triagem nutricional como instrumento preditor de desfechos clínicos em pacientes cirúrgicos. Revista Ciências & Saúde., v. 25, n. 1, 2014.

WORLD HEALTH ORGANIZATION. Physical status: The use and interpretation of anthropometry. WHO Technical Report Series nº 856. [internet] Geneva: World Health Organization; 1995. [Available from: » https://www.who.int/childgrowth/publications/physical_status/en/.

Lipschitz, DA. Screening for nutritional status in the elderly. Prim Care. 1994;21(1):5567. DOI: https://doi.org/10.1016/S0095-4543(21)00452-8

Stefani LC, Gutierrez CS, Castro SMJ, Zimmer RL, Diehl FP, Meyer LE, et al. Derivation and validation of a preoperative risk model for postoperative mortality (SAMPE model): An approach to care stratification. PLoS One. 201712(10): e0187122. DOI: https://doi.org/10.1371/journal.pone.0187122

Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. Diretriz ACC / AHA de 2014 sobre avaliação cardiovascular perioperatória e manejo de pacientes submetidos à cirurgia não cardíaca: resumo executivo: um relatório do American College of Cardiology / American Heart Association Task Force on Practice Guidelines. Circulação. 2014;130(24):2215-45. DOI: https://doi.org/10.1161/CIR.0000000000000106

Raslan M, Gonzalez MC, Gonçalves Dias MC, Paes-Barbosa FC; Cecconello I, et al. Aplicabilidade dos métodos de triagem nutricional no paciente hospitalizado. Rev Nutr. 2008;21(5):553-61. DOI: https://doi.org/10.1590/S1415-52732008000500008

Raslan M, Gonzalez MC, Dias MCG, Nascimento M, Castro M, Marques P, et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutr. 2010;26:721-6. DOI: https://doi.org/10.1016/j.nut.2009.07.010

Toledo DO, Piovacari SMF, Horie LM, Matos LBN, Castro MG, Ceniccola G, et al. Campanha “Diga não à desnutrição”: 11 passos importantes para combater a desnutrição hospitalar. BRASPEN J. 2018;33(1):86-100.

Gabbardo RAR, Boscaini C. Risco nutricional em pacientes adultos e idosos de um hospital do sul do Brasil. Sci Med. 2014;24(2):123-29. DOI: https://doi.org/10.15448/1980-6108.2014.2.16325

Sierra JC, Dock Nascimento DB, Behne TEG, Thé MBS, Rodrigues HHNP, Andreo FO, et al. Cirurgia oncológica de grande porte reduz a função muscular de pacientes com e sem risco nutricional. Rev Col Bras Cir. 2020;47: e20202470. DOI: https://doi.org/10.1590/0100-6991e-20202470

Soares BLM, Burgos MGPA. Nutritional risk among surgery patients and associations with hospital stay and postoperative complications. Nutr Hosp 2014;30(3):636-42.

Carneiro LMR, Santos MPA, Macena RHM, Vasconcelos TB. Atenção integral à saúde do homem: um desafio na atenção básica. Rev Bras em Promoç Saúde. 2016;29(4):554 DOI: https://doi.org/10.5020/18061230.2016.p554

Garcia RS, Tavares LRD, Pastore CA. Rastreamento nutricional em pacientes cirúrgicos de um hospital universitário do sul do Brasil: o impacto do risco nutricional em desfechos clínicos. Einstein 2013;11(2):147-52. DOI: https://doi.org/10.1590/S1679-45082013000200002

Barbosa AAO, Vicentini AP, Langa FP. Comparação dos critérios da NRS-2002 com o risco nutricional em pacientes hospitalizados. Rev. Ciências & Saúde Coletiva. 2019;24(9):3325-34. DOI: https://doi.org/10.1590/1413-81232018249.25042017

Li SY, Yu JH, Diao ZF, Zeng L, Zeng MJ, Shen XF, et al. Análise da triagem de risco nutricional e fatores influenciadores de pacientes hospitalizados em área central urbana. J Huazhong Univ Sci Technolog Med Sci. 2017;37(4):628-34. DOI: https://doi.org/10.1007/s11596-017-1782-0

Oliveira RCS, Soares BLM, Maio R, Santos AMS, Burgos MGPA. Associações do Risco nutricional com tempo de internamento e complicações hospitalares: estudo em pacientes de ginecologia do NE do Brasil. Nutr Clín Diet Hosp. 2020;40(4):77-83.

Drescher T, Singler K, Ulrich A, Koller M, Keller U, Christ-Crain M, et al. Comparison of two malnutrition risk screening methods (MNA and NRS 2002) and their association with markers of protein malnutrition in geriatric hospitalized patients. Eur J Clin Nutr. 2010;64(8):887-93. DOI: https://doi.org/10.1038/ejcn.2010.64

Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo G, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) "cachexia-anorexia in chronic wasting diseases" and "nutrition in geriatrics". Clin Nutr. 2010;29(2):154-9. DOI: https://doi.org/10.1016/j.clnu.2009.12.004

Santos HVD, Araújo CMS. Estado nutricional pré-operatório e incidência de complicações cirúrgicas em pacientes idosos do Estado de Pernambuco (Brasil) submetidos a cirurgias gastrointestinais. Nutr Clín Diet Hosp. 2014;34(1):41-9.

Tangvik RJ, Tell GS, Guttormsen AB, Eisman JA, Henriksen A, Nilsen RM, Ranhoff AH. Nutritional risk profile in a university hospital population. Clin Nutr. 2015;34(4):70511. DOI: https://doi.org/10.1016/j.clnu.2014.08.001

Nunes PP, Marshall NG. Nutritional Risk Screening (NRS 2002) como instrumento preditor de desfechos pós-operatórios em pacientes submetidos a cirurgias gastrointestinais. Rev Bras Nutr Clín, 2015;30(2):120-125.

Thomas MN, Kufeldt J, Kisser U, Hornung HM, Hoffmann J, Andraschko M, et al. Efeitos da desnutrição nas taxas de complicações, tempo de internação hospitalar e receita em pacientes cirúrgicos eletivos no sistema G-DRG. Nutrição. 2016;32 (2): 249-54. DOI: https://doi.org/10.1016/j.nut.2015.08.021

Kami AA, Fernandes R, Quadros Camargo C, Corsi DM, Salles RK, Moraes Trindade EB. Nutrition risk screening in patients admitted to an adult emergency department of a Brazilian University Hospital. Nutr Clin Pract. 2017;32(1):84-91. DOI: https://doi.org/10.1177/0884533616656339

Maia I, Xará S, Vaz D, Shiang T, Amaral TF. Undernutrition risk at hospital admission and length of stay among pulmonology inpatients. Pulmonology. 2018;24(6):330-36. DOI: https://doi.org/10.1016/j.pulmoe.2018.01.004

Badosa L E, Tahull MB, Casas VN, Sangrador EG, Méndez FC, et al. Triagem de desnutrição hospitalar na admissão: a desnutrição aumenta a mortalidade e o tempo de internação. Nutr Hosp. 2017;34(4) 907-13.