Malnutrition and clinical outcome in urological patients


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In a previous study we evaluated the risk for malnutrition among urological patients in a German university hospital. There are published different studies in other surgical fields that could show a correlation between malnutrition and clinical outcome. As data on this issue is still rare in the urological field we aimed to correlate the risk of malnutrition with different parameters regarding clinical outcome. Methods In the time from 2007 to 2009 a total of 320 patients were evaluated regarding the risk of malnutrition and occurrence of complications during the time of hospitalization at our Urological department. The Nutritional risk screening 2002 (NRS) by Kondrup et al. was used for the estimation of the risk level for malnutrition. Patients of a German university hospital were included independently of intervention, age or gender. Parameters for clinical outcome were: pulmonary complications (infectious/noninfectious), cardiovascular complications (infectious/noninfectious), other infections (urinary tract infection etc.), wound healing disorders and time of hospitalization. Results In this evaluation 320 patients were included for analysis. Forty patients (13%) presented with a normal nutritional status (NRS score 0) at the time of admission to the hospital and 212 patients (66%) were at risk for forming malnutrition problems (NRS score 1-2). sixty eight patients (21%) of this urological cohort were detected with a malnutrition according to the applied NRS score (≥3). Regarding the occurrence of overall complications in this cohort the rate was rather low compared to other surgical fields. Of 320 patients only 22 patients (7%) presented with relevant complications during their hospitalization. However if data were stratified for peri- and postoperative complications in correlation to nutritional status of patients, an evident trend to a higher complication rate of 9% was obvious. Conclusions In our cohort of exclusively urological patients, the risk for post-surgical complications was higher in patients who were malnourished as defined using the Nutritional Risc Screening System (NRS) by Kondrup et al. Further studies need to show whether an adequate nutritional supportive therapy could help to optimize the clinical outcome of malnourished urological patients.



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Published 01 January 2011
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ocTOber 10, 2011
EUr J MeD ReS (2011) 16: 469-472
EuRoPEan JouRnal oF MEdICal REsEaRCH
469 © I. HOLzàpfeL PUbLiSherS 2011
MalnutRItIon andClInICaloutCoME InuRologICalPatIEnts
1 11 1 11 22 a. KàrL, M. sTàehLer, R. BàUer, s. triTSchLer, Y. HOcàOGLU , a. BUchNer, J. HOffmàNN , d. KUppiNGer, 1 2 C. sTief, P. RiTTLer
1 depàrTmeNT Of urOLOGy, uNiverSiTy Of MUNich-CàmpUS grOSShàDerN, MUNich, germàNy 2 sUrGicàL depàrTmeNT, uNiverSiTy Of MUNich-CàmpUS grOSShàDerN, MUNich, germàNy
AbstractKey words:MàLNUTriTiON, urOLOGy, oUTcOme, ObServà-Intr oduction:IN à previOUS STUDy we evàLUàTeD The riSkTiONàL STUDy fOr màLNUTriTiON àmONG UrOLOGicàL pàTieNTS iN à ger-màN UNiverSiTy hOSpiTàL. there àre pUbLiSheD DiffereNTIntRoduCtIon STUDieS iN OTher SUrGicàL fieLDS ThàT cOULD ShOw à cOrre-LàTiON beTweeN màLNUTriTiON àND cLiNicàL OUTcOme. aSthe àSSOciàTiON beTweeN màLNUTriTiON àND pàTieNTS´ DàTà ON ThiS iSSUe iS STiLL ràre iN The UrOLOGicàL fieLD weOUTcOme hàS beeN eSTàbLiSheD fOr DiffereNT DiSeàSeS àimeD TO cOrreLàTe The riSk OfmàLNUTriTiON wiTh Differ-àND meDicàL fieLDS. làrGe cOhOrT STUDieS cOULD ShOw à eNT pàràmeTerS reGàrDiNG cLiNicàL OUTcOme.cLOSe àSSOciàTiON beTweeN màLNUTriTiON àND iNcreàSeD Methods:IN The Time frOm 2007 TO 2009 à TOTàL Of320 cOmpLicàTiONràTe, mOrTàLiTy, LeNGTh OfhOSpiTàL STày pàTieNTS were evàLUàTeD reGàrDiNG The riSk OfmàLNUTri- àNDcOSTS [2, 9]. HOSpiTàL màLNUTriTiON iN GeNeràL hàS TiON àND OccUrreNce OfcOmpLicàTiONS DUriNG The TimebeeN iNveSTiGàTeD befOre, whereàS NO SpeciàL iNTereST Of hOSpiTàLizàTiONàT OUr urOLOGicàL DepàrTmeNT. thewàS pàiD TO UrOLOGicàL pàTieNTS iN pàrTicULàr. aS DàTà ON nUTriTiONàL riSk ScreeNiNG 2002 (nRs) by KONDrUp eTThiS iSSUe SeemeD TO be ràre iN The urOLOGicàL fieLD we àL. wàS USeD fOr The eSTimàTiON OfThe riSk LeveL fOrperfOrmeD à STUDy iN 2007 TO eSTimàTe The prevàLeNce màLNUTriTiON. PàTieNTS Ofà germàN UNiverSiTy hOSpiTàLOf màLNUTriTiONàmONG urOLOGicàL pàTieNTS ON àN Oper-were iNcLUDeD iNDepeNDeNTLy OfiNTerveNTiON, àGe OràTive wàrD Ofà germàN UNiverSiTy hOSpiTàL. ReSULTS Of GeNDer. PàràmeTerS fOr cLiNicàL OUTcOme were: pUL-ThiS STUDy were pUbLiSheD iN urOLOGy iN 2009 [4]. ac-mONàry cOmpLicàTiONS (iNfecTiOUS/NONiNfecTiOUS), càr-cOrDiNG TO ThiS STUDy, màLNUTriTiON wàS DiàGNOSeD iN DiOvàScULàr cOmpLicàTiONS (iNfecTiOUS/NONiNfecTiOUS),16% Of897 iNcLUDeD pàTieNTS (nRs scOre ≥3). the OTher iNfecTiONS (UriNàry TràcT iNfecTiON eTc.), wOUNDnRs ScOre wàS àSSeSSeD àT ScOre 0 (NO màLNUTriTiON), heàLiNG DiSOrDerS àND Time OfhOSpiTàLizàTiON. 1-2(riSk fOr màLNUTriTiON) àND 3-5 (màLNUTriTiON) iN 45, Results:708 àND 144 pàTieNTS, reSpecTiveLy. aGe àND màLiGNàNTIN ThiS evàLUàTiON 320 pàTieNTS were iNcLUDeD fOr àNàLySiS. FOrTy pàTieNTS (13%) preSeNTeD wiTh àDiSeàSe were SiGNificàNT riSk fàcTOrS fOr màLNUTriTiON NOrmàL NUTriTiONàL STàTUS (nRs ScOre 0) àT The Time Of(p<0.001). aLSO The Type OfSUrGery wàS SiGNificàNTLy àDmiSSiON TO The hOSpiTàL àND 212 pàTieNTS (66%) wereàSSOciàTeD wiTh The riSk OfmàLNUTriTiON (p<0.001). àT riSk fOr fOrmiNG màLNUTriTiON prObLemS (nRs ScOregeNDer àND bODy màSS iNDex hàD NO SiGNificàNT iNfLU-1-2). sixTy eiGhT pàTieNTS (21%) OfThiS UrOLOGicàL cO-eNce. hOrT were DeTecTeD wiTh à màLNUTriTiON àccOrDiNG TOaS ThiS fOrmer STUDy fOcUSeD excLUSiveLy ON The eSTi-The àppLieD nRs scOre (≥3). ReGàrDiNG The OccUrreNcemàTiON OfThe prevàLeNce OfmàLNUTriTiON àmONG UrO-Of OveràLLcOmpLicàTiONS iN ThiS cOhOrT The ràTe wàSLOGicàL pàTieNTS The NOw preSeNTeD fOLLOw Up STUDy ràTher LOw cOmpàreD TO OTher SUrGicàL fieLDS. of320 àimeDTO DeTecT à pOSSibLe cOrreLàTiON beTweeN màLNU-pàTieNTS ONLy 22 pàTieNTS (7%) preSeNTeD wiTh reLevàNTTriTiON àND cLiNicàL OUTcOme OfUrOLOGicàL pàTieNTS. cOmpLicàTiONS DUriNG Their hOSpiTàLizàTiON. HOwever ifaS TOOL fOr The evàLUàTiON OfmàLNUTriTiON The nU-DàTà were STràTifieD fOr peri- àND pOSTOperàTive cOmpLi-TriTiONàL screeNiNG scOre by KONDrUp àT àL. wàS USeD càTiONS iN cOrreLàTiON TO NUTriTiONàL STàTUS OfpàTieNTS, àGàiN. àN eviDeNT TreND TO à hiGher cOmpLicàTiON ràTe Of9% wàS ObviOUS.MEtHods Conclusions:IN OUr cOhOrT OfexcLUSiveLy UrOLOGicàL pàTieNTS, The riSk fOr pOST-SUrGicàL cOmpLicàTiONS wàS320 pàTieNTSIN The Time frOm 2007 TO 2009 à TOTàL Of hiGher iN pàTieNTS whO were màLNOUriSheD àS DefiNeDwere ScreeNeD àND evàLUàTeD prOSpecTiveLy reGàrDiNG USiNG The nUTriTiONàL RiSc screeNiNG sySTem (nRs) bycOmpLi-màLNUTriTiON àND The OccUrreNce OfThe riSk Of KONDrUp eT àL.FUrTher STUDieS NeeD TO ShOw wheTherhOSpiTàLizàTiON àT OUr urO-càTiONS DUriNG The Time Of àN àDeqUàTe NUTriTiONàL SUppOrTive Theràpy cOULD heLpLOGicàL DepàrTmeNT. the nUTriTiONàL riSk ScreeNiNG TO OpTimize The cLiNicàL OUTcOme OfmàLNOUriSheD UrO-2002 (nRs) by KONDrUp eT àL. wàS USeD fOr The eSTimà-LOGicàL pàTieNTS.TheSe pàTieNTS.The riSk LeveL fOr màLNUTriTiON OfTiON Of