José Luiz Braga de Aquino

Nutrition Status and Risk Factors Associated With Length of Hospital Stay for Surgical Patients

OBJECTIVE To diagnose the nutrition status of hospitalized patients and identify the risk factors associated with hospital length of stay (LOS). METHODS The subjective approach and the body mass index (BMI) were used to classify the nutrition status, and other indicators (anthropometry, biochemistry, and energy intake) were analyzed regarding their association with length of hospital stay of 350 patients. The chi-square test was used to compare proportions, and the Mann-Whitney or Kruskal-Wallis test was used to compare continuous measures. Linear association was verified using Spearmans rank correlation coefficient. Coxs regression model was used to investigate factors associated with LOS. RESULTS Disease was the factor that influenced LOS the most in the studied population. Longer LOS prevailed in males (P < .0001), patients aged ≥60 years (P = .0008), patients with neoplasms (P < .0001), patients who lost weight during their hospital stay (P < .0001), and malnourished patients (P = .0034). There was a negative and significant, but weak, correlation between LOS and nutrition indicators (calf circumference, arm circumference, triceps skinfold thickness, subscapular skinfold thickness, arm fat area, lymphocyte count, and hemoglobin). Among adults, well-nourished patients were 3 times more likely to be discharged sooner (P = .0002, RR = 3.3 [1.7-6.2]) than those who had some degree of malnutrition. Well-nourished patients with digestive tract diseases (DTD) were also discharged sooner than malnourished patients with the same condition (P = .02, RR = 2.5 [1.1-5.8]). In patients with neoplasms, arm circumference was an independent risk factor to assess LOS (P = .009, RR = 1.1 [1.0-1.1]). CONCLUSIONS LOS was associated with disease and nutrition status. Among the more common diseases, nutrition status according to the subjective approach determined the LOS for patients with DTD and nutrition status according to arm circumference determined the LOS for patients with neoplasms.

Clinical and nutritional status of surgical patients with and without malignant diseases: cross-sectional study

CONTEXT Malnutrition is frequently observed in inpatients with malignant diseases and may contribute to longer hospital stays. OBJECTIVE To compare the nutritional status, lymphocyte count, hemoglobin values and length of hospital stay of patients with and without malignant diseases. METHODS This comparative study assessed indicators of nutritional status, namely body mass index, recent weight loss, lymphocyte count, hemoglobin and length of hospital stay, of 928 surgical patients with and without malignant diseases (50.2% females and 49.8% males). The chi-square test was used to compare proportions and the Mann-Whitney test was used to compare continuous measurements between two groups. The significance level was set at 5%. RESULTS Patients with malignant diseases had longer hospital stays (P<0.0001), furthermore, a higher percentage of patients with malignant diseases had body mass index <18.5 (P<0.0001) and experienced recent weight changes (P<0.0002). Lymphocyte count also differed statistically between the groups (P = 0.0131), which lower levels were identified among patients with malignant diseases. CONCLUSION The lymphocyte count, hemoglobin values and weight loss are important findings of nutritional depletion in patients with malignant diseases.

Tratamento cirúrgico do megaesôfago recidivado

BACKGROUND: To evaluate the surgical treatment results in a series of patients submitted to previous treatments for megaesophagus, which their symptoms recurred. METHOD: We analyzed the results of many different surgical techniques performed in 47 patients at the General and Thoracic Surgery Department of HMCP-PUC-Campinas. Our follow-up considered postoperative results as follows: development of new symptoms, relief of old symptoms, morbidity, and mortality. We divided the patients in three groups in accordance to the disease degree: Incipient (9 cases), not advanced (18 cases) and advanced (20 cases). The techniques used were Hellers modified cardiomyotomy, Thals esophagocardioplasty, Serra-Dorias esophagocardioplasty, subtotal esophagectomy with mucosectomy and conservation of the esophagus muscular layer. RESULTS: For incipient megaesophagus, the cardiomyotomy technique obtained good results, with low morbidity. For not advanced megaesophagus, the cardioplasty, in special the Serra Dorias esophagocardioplasty, was the best choice. The procedures used for advanced megaesophagus had the greatest morbidity rates; however, they also showed superiority for aggressive techniques comparing with the conservative operations, in special the mucosectomy with conservation of the esophagus muscular layer, being this the technique with less morbidity within this group. CONCLUSION: It is difficult to choose a standard procedure for megaesophagus with previous surgical treatment due to several available techniques, and different personal surgeon skills, in such way to create therapeutical protocols.

Comparison of nutritional diagnosis methods and prediction of clinical outcomes in patients with neoplasms and digestive tract diseases

BACKGROUND & AIMS Nowadays studies are advised to compare nutritional risk assessed by different instruments with clinical outcomes. This study compared nutritional diagnosis methods and identified the best predictor of clinical outcomes. METHODS This cross-sectional study included 500 hospitalized patients with neoplasms and digestive tract diseases (DTD). Their nutritional status was determined by nutritional risk screening (NRS), subjective global assessment (SGA), and anthropometry, and compared with the clinical outcomes. The Kappa coefficient measured the agreement between the methods. Associations between risk factors and clinical outcomes were investigated by Cox, univariate logistic, and multiple logistic regression analyses at a significance level of 5%. RESULTS In DTD and cancer patients, SGA and NRS presented good agreement, but agreement of either with anthropometry was poor. According to Cox regression, both SGA and NRS predicted complications in DTD patients. However, none of the instruments was capable of predicting complications in cancer patients or death in DTD patients. In cancer patients, SGA and age were considered risk factors for death. In DTD patients, age, SGA, and NRS predicted a long hospital stay. In cancer patients, long stays were associated with age and SGA. CONCLUSION SGA and NRS are highly sensitive for predicting complications in DTD patients. Old age and SGA predicted death in cancer patients. Advanced age and SGA also predicted long hospital stays for DTD and cancer patients, but NRS predicted long hospital stays only for DTD patients.

Marginal mandibulectomy in the surgical treatment of tonsil and retromolar trigone tumours

UNLABELLED Resection of the ascending ramus of the mandible can result in considerable functional and esthetic damage. AIM To compare the survival rate and local and regional recurrence in marginal and segmental mandibulectomy for advanced tonsil and retromolar trigone tumours with no mandibular invasion. PLACE AND PERIOD: Reference Head & Neck Service, between October 1994 and December 2001. MATERIAL AND METHOD 20 stage IV patients undergoing marginal mandibulectomy and 22 undergoing segmental mandibulectomy were compared. CASE STUDY a contemporary cross-sectional cohort study. RESULTS Of 20 patients undergoing marginal mandibulectomy, 35% died of the disease, 15% due to local recurrence, 15% due to regional recurrence and 5% due to local and regional recurrence. Of 22 patients undergoing segmentary mandibulectomy, 36,4% died of the disease, 31,8% due to local recurrence and 13,6% due to distant recurrence. The Kaplan-Meier analysis showed a 55% survival rate for the marginal mandibulectomy group, and a 45% survival rate for the segmental group (p= 0.8329). CONCLUSIONS Analysis of the two groups showed that conservation of the ascending ramus of the mandible, even in advanced lesions with no mandibular involvement, does not increase the recurrence rate.

A mandibulectomia marginal no tratamento dos tumores de loja amigdalina e região retromolar

Resection of the ascending ramus of the mandible can result in considerable functional and esthetic damage. AIM: To compare the survival rate and local and regional recurrence in marginal and segmental mandibulectomy for advanced tonsil and retromolar trigone tumours with no mandibular invasion. PLACE AND PERIOD: Reference Head & Neck Service, between October 1994 and December 2001. MATERIAL AND METHOD: 20 stage IV patients undergoing marginal mandibulectomy and 22 undergoing segmental mandibulectomy were compared. CASE STUDY: a contemporary cross-sectional cohort study. RESULTS: Of 20 patients undergoing marginal mandibulectomy, 35% died of the disease, 15% due to local recurrence, 15% due to regional recurrence and 5% due to local and regional recurrence. Of 22 patients undergoing segmentary mandibulectomy, 36,4% died of the disease, 31,8% due to local recurrence and 13,6% due to distant recurrence. The Kaplan-Meier analysis showed a 55% survival rate for the marginal mandibulectomy group, and a 45% survival rate for the segmental group (p= 0.8329). CONCLUSIONS: Analysis of the two groups showed that conservation of the ascending ramus of the mandible, even in advanced lesions with no mandibular involvement, does not increase the recurrence rate.

Neoplasia digestiva, baixo índice de massa corporal e perda de peso como indicadores do tempo de internação em pacientes portadores de neoplasias

RACIONAL: O estado de pacientes portadores de neoplasias pode influenciar o tempo de internacao. OBJETIVO: Investigar as alteracoes nutricionais e estudar os fatores de risco associados ao tempo de internacao em pacientes portadores de neoplasias. METODOS: Foi investigado em um estudo transversal o estado nutricional por antropometria classica, consumo energetico, alteracoes gastrointestinais, indicadores de risco nutricional e tempo de internacao em 93 pacientes portadores de neoplasias. Posteriormente foram estimados os fatores de risco associados ao tempo de internacao prolongado. RESULTADOS: Verificou-se diferenca significativa quanto ao tempo de internacao, para os pacientes com neoplasias digestivas que apresentaram 26 vezes mais chance de ficar internado sete dias ou mais do que pacientes com neoplasia ginecologica. Aqueles com IMC<18,5 apresentaram oito vezes mais chance de ficar internado sete dias ou mais. Os pacientes que apresentaram perda de peso recente, apresentaram 4,5 vezes mais chance de ficar internado sete dias ou mais do que aqueles que nao apresentaram perda de peso. CONCLUSAO: Pacientes portadores de neoplasias digestivas, com baixo IMC e perda de peso sao considerados fatores de risco para maior tempo de internacao.

Investigation of nutritional risk factors using anthropometric indicators in hospitalized surgery patients

CONTEXT The investigation of risk factors associated with nutritional status could contribute for better knowledge of the malnutrition. OBJECTIVE To investigate the incidence of malnutrition and its possible association with many parameters that assess nutritional status and to identify the associated risk factors. METHODS The nutritional status was assessed in 235 hospitalized patients. Malnutrition was defined as present when the patient presented at least two anthropometric criteria below the normal range and habitual energy intake below 75% of the energy requirement (HEI/ER<75%). Gender, age, type of disease, recent weight change and dental problems were investigated as possible associated risk factors. The chi-square and Mann-Whitney tests were used to compare the data and univariate and multiple logistic regressions were used to identify the factors associated with malnutrition. The odds ratio (OR) and confidence interval (CI) of 95% were calculated with the significance level set at 5% (P<0.05). RESULTS One-fifth (20%) of the patients were malnourished on admission to the hospital and 27.5% reported recent weight loss. Malnutrition (P<0.0001) was greater in patients with malignant diseases. The only variables significantly associated with malnutrition according to univariate logistic regression were recent weight loss (P = 0.0058; OR = 2.909; IC95% = 1.362; 6.212) and malignant disease (P = 0.0001; OR = 3.847; IC95% = 1.948; 7.597). When multiple regression was used in the model which included type of disease, malignant disease was shown to increase the chance of malnutrition fourfold (P = 0.0002; OR = 3.855; IC95% = 1.914; 7.766). When disease was excluded, recent weight loss also increased malnutrition fourfold (P = 0.0012; OR = 3.716; IC95% = 1.677; 8.236). CONCLUSION Patients with a history of recent weight loss and those with malignant diseases are more susceptible to malnutrition.

Dental and gastrointestinal changes as indicators of nutritional depletion in elderly inpatients

OBJECTIVE The objective of this study was to identify the associations between the nutritional status of elderly patients and length of hospital stay and presence of dental and gastrointestinal changes. CASUISTIC AND METHOD This cross-sectional study analyzed anthropometric and food intake indicators, dental and gastrointestinal changes and length of hospital stay of 441 elderly patients of both genders. The Pearsons correlation coefficient was used to verify the correlation between the nutritional status of the elderly patients and length of hospital stay and presence of dental and gastrointestinal changes. The significance level was set at P < 0.05. RESULTS Dietary and anthropometric variables as well as length of hospital stay were similar for patients with and without dental changes. Patients with gastrointestinal changes consumed less energy (P < 0.05) than patients without gastrointestinal changes. Length of hospital stay was inversely correlated with body mass index (r = -0.15; P < 0.05); arm circumference was inversely correlated with presence of dental changes (r = -0.12; P < 0.05) and mid-arm muscle circumference was inversely correlated with gastrointestinal changes (r = -0.12; P < 0.05). CONCLUSION Dental and gastrointestinal changes are important indicators of nutritional depletion and dietary intake of inpatients.