New Screening Tool Helps ID Heart Surgery Patients at Risk for Malnutrition

Patients who are at risk for malnutrition when undergoing heart surgery now can be more quickly and easily identified, leading to intervention and potentially better surgical outcomes, according to a study published online in The Annals of Thoracic Surgery.

Malnutrition resulting from inadequate calorie intake during the postoperative period is associated with high morbidity and mortality, as well as delayed recovery, increased hospital stay, early readmission, decreased quality of life, and increased health care costs.

"Nevertheless, days in the ICU can go by quickly before we realize patients are not getting the nutritional support they need to improve recovery," says senior author Glenn Whitman, MD, of Johns Hopkins Hospital (JHH) in Baltimore. "This study offers a nutrition risk score that may heighten our sensitivity to patients who are most at risk for needing nutritional support, allowing them to receive intervention sooner than we might have done in the past."

Whitman and colleagues at JHH and Brigham and Women's Hospital in Boston identified 1,056 adult open heart surgery patients from their institutions in 2012. Among this cohort, 87 (8%) required postoperative nutrition support. The patients who required nutrition support were more likely than their counterparts to have diabetes and chronic obstructive pulmonary disease.

The group then developed a JHH Nutrition Score generated by seven variables, such as prior cardiac interventions, white blood cell count, and urgent/emergent operation status, that independently predicted the need for nutrition support. Each variable was given a number if it was abnormal, with higher total scores demonstrating increased need for nutrition support.

"The JHH risk score can be used as a screening tool to divide cardiac surgery admissions into low or high risk for needing nutrition support," Whitman says. "By adding up the total point score, we can look at patients and determine how at risk they are for being unable to eat during the initial ICU period. If the patients are at high risk, and we know that, we can start nutrition sooner."

The variables used for the JHH Nutrition Score are "readily accessible," all available immediately from the chart at the time of ICU admission, and the score is easily calculable and highly predictive, Whitman explains. In contrast, markers from other nutrition risk tools require more history and understanding of patients, so there are substantial limitations when applied to an ICU admission.

The researchers validated the JHH Nutrition Score by applying the scores to 1,336 patients who underwent heart surgery in 2015 at their institutions. The scores strongly correlated to the 115 (8.6%) who required postoperative nutrition support.

"In using the JHH Nutrition Score to accurately identify the at-risk patients and then aggressively pursuing nutrition support, we may improve substantially upon their current poor outcomes," Whitman says. "Individualized nutrition strategies, combined with the expertise of the nutrition support team and the clinical approach of the caregiver, may further enhance the management of these patients."

Source:  The Society of Thoracic Surgeons