The Possible Impact of DRGs on Nutritional Status of Patients Having Surgery for Cancer of the Head and Neck FREE

Bernard S. Linn, MD; David S. Robinson, MD

[+] Author Affiliations

Reprint requests to Veterans Administration Medical Center (141), 1201 NW 16th St, Miami, FL 33125 (Dr Linn).

JAMA. 1988;260(4):514-518. doi:10.1001/jama.1988.03410040086033

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ABSTRACT

ABSTRACT | REFERENCES

Our purpose was to determine if the introduction of prospective payment according to diagnosis related groups (DRGs) was associated with any adverse effect on the nutritional status of patients undergoing massive resections for head and neck cancer. The hypothesis was that malnourished patients, in particular those admitted since prospective payment was instituted, would be less well nourished at the time of surgery due to shortened preoperative stays, and, therefore, they would have more postoperative complications than malnourished patients admitted before DRGs. We compared 59 male patients with cancer of the head and neck admitted for massive resections before the introduction of DRGs with 61 similar patients admitted after the introduction of DRGs. These patients were classified as being either malnourished or well nourished. Nutritional status did not differ significantly at admission but was worse at surgery after the introduction of DRGs. In malnourished patients, complication scores were over two times higher after the introduction of DRGs. We conclude that malnourished patients have not fared as well since the prospective payment system was introduced and that other ways need to be devised so malnourished patients can be treated, such as adjusting DRG payments or providing preadmission nutritional support.

(JAMA 1988;260:514-518)

REFERENCES

ABSTRACT | REFERENCES

Civetta JM, Hudson-Civetta JA: Maintaining quality of care while reducing changes in ICU: Ten ways . Ann Surg 1985;;202:524-530.

Glenn JK: Surgeons living under DRGs . ACS Bull 1986;;71:7-8.

Mullen JL, Gertner MH, Buzby GP, et al: Implications of malnutrition in the surgical patient . Arch Surg 1979;;114:121-125.

Reinhardt GF, Myscofski JW, Wilkens DB, et al: Incidence and mortality of hypoalbuminemic patients in hospitalized veterans . JPEN 1980;;4:357-359.

Anderson CF, Moxness K, Meister J, et al: The sensitivity and specificity of nutrition-related variables in relationship to duration of hospital stay and rate of complications . Mayo Clin Proc 1984;;59:477-483.

Robinson G, Goldstein M, Levine GM: Impact of nutritional status on DRG length of stay . JPEN 1987;;11:49-51.

Silverberg E, Lubera J: Cancer statistics, 1987 . CA 1987;;37:2-19.

Linn BS: A protein energy malnutrition scale (PEMS) . Ann Surg 1984;;200:747-752.

Muller JM, Keller HW, Brenner V, et al: Indications and effect of preoperative parenteral nutrition . World J Surg 1986;;10:53-63.

Mullen JL, Buzby GP, Matthews DC, et al: Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support . Ann Surg 1980;;192:604-613.

Fischer JE: Use of parenteral nutrition in patients with cancer . Surgery 1985;;97:756-758.

Anderson GF, Steinberg EP: DRGs and specialized nutritional support. Prospective payment and support: The need for reform . JPEN 1986;; 10:3-8.

Brolin RE, Smith C, Mast B, et al: DRG: Impact of nutritional support in cardiac surgery patients . Read before the Tenth Clinical Congress of Nutrition, Dallas, Feb 12,1986 .

Kreis DJ Jr, Augenstein D, Civetta JM, et al: Diagnosis-related groups and the salvageable trauma patient in the intensive care unit . Surg Gynecol Obstet 1986;;163:539-542.

Dudrich SJ, O'Donnell JJ, Englert DM, et al: One hundred patient-years of ambulatory home total parenteral nutrition . Ann Surg 1984;;199:770-781.

Howard L, Heaphey LL, Tunchalk M: A review of current national status of home parenteral and enteral nutrition from provider and consumer perspective . JPEN 1986;;10:416-424.

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