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Impact of Malnutrition on Outcomes Following Transcatheter Aortic Valve Implantation (from a National Cohort)

Published:January 07, 2020DOI:https://doi.org/10.1016/j.amjcard.2019.12.038
      Malnutrition is associated with increased mortality in open cardiac surgery, but its impact on transcatheter aortic valve implantation (TAVI) is unknown. This study utilized the National Readmissions Database to evaluate the impact of malnutrition on mortality, complications, length of stay (LOS), 30-day readmission, and total charges following TAVI. Adult patients undergoing isolated TAVI for severe aortic stenosis were identified using the 2011 to 2016 National Readmissions Database, which accounts for 56.6% of all US hospitalizations. The malnourished cohort included patients with nutritional neglect, cachexia, protein calorie malnutrition, postsurgical nonabsorption, weight loss, and underweight status. Multivariable models were utilized to evaluate the impact of malnutrition on selected outcomes. Of 105,603 patients, 5,280 (5%) were malnourished. Malnourished patients experienced greater mortality (10.4% vs 2.2%, p <0.001), postoperative complications (49.2% vs 22.6%, p <0.001), 30-day readmission rates (21.4 vs 14.9%, p <0.001), index hospitalization charges ($331,637 vs $208,082, p <0.001), and LOS (16.4 vs 6.2 days, p <0.001) relative to their nourished counterparts. On multivariable analysis, malnutrition remained a significant, independent predictor of increased index mortality (Adjusted odds ratio (AOR) = 2.68, p <0.001), complications (AOR = 2.09, p <0.001), and 30-day readmission rates (AOR = 1.34, p <0.001). Malnutrition was most significantly associated with infectious complications at index hospitalization (AOR = 3.88, p <0.001) and at 30-day readmission (AOR = 1.43, p <0.027). In conclusion, malnutrition is independently associated with increased mortality, complications, readmission, and resource utilization in patients undergoing TAVI. Preoperative risk stratification and malnutrition modification may improve outcomes in this vulnerable population.
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      References

        • Thyregod HGH
        • Steinbrüchel DA
        • Ihlemann N
        • Nissen H
        • Kjeldsen BJ
        • Petursson P
        • Chang Y
        • Franzen OW
        • Engstrøm T
        • Clemmensen P
        • Hansen PB
        • Andersen LW
        • Olsen PS
        • Søndergaard L
        Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the All-Comers NOTION Randomized Clinical Trial.
        J Am Coll Cardiol. 2015; 65 (Available at:): 2184-2194
        • Mack MJ
        • Leon MB
        • Smith CR
        • Miller DC
        • Moses JW
        • Tuzcu EM
        • Webb JG
        • Douglas PS
        • Anderson WN
        • Blackstone EH
        • Kodali SK
        • Makkar RR
        • Fontana GP
        • Kapadia S
        • Bavaria J
        • Hahn RT
        • Thourani VH
        • Babaliaros V
        • Pichard A
        • Herrmann HC
        • Brown DL
        • Williams M
        • Davidson MJ
        • Svensson LG
        • Akin J
        5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial.
        Lancet. 2015; 385 (Available at:): 2477-2484
        • Reardon MJ
        • Van Mieghem NM
        • Popma JJ
        • Kleiman NS
        • Sondergaard L
        • Mumtaz M
        • Adams DH
        • Deeb GM
        • Maini B
        • Gada H
        • Chetcuti S
        • Gleason T
        • Heiser J
        • Lange R
        • Merhi W
        • Oh JK
        • Olsen PS
        • Piazza N
        • Williams M
        • Windecker S
        • Yakubov SJ
        • Grube E
        • Makkar R
        • Lee JS
        • Conte J
        • Vang E
        • Nguyen H
        • Chang Y
        • Mugglin AS
        • Serruys PWJC
        • Kappetein AP
        Surgical or transcatheter aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2017; 376: 1321-1331
        • Fávaro-Moreira NC
        • Krausch-Hofmann S
        • Matthys C
        • Vereecken C
        • Vanhauwaert E
        • Declercq A
        • Bekkering GE
        • Duyck J
        Risk factors for malnutrition in older adults: a systematic review of the literature based on Longitudinal Data.
        Adv Nutr. 2016; 7 (Available at:): 507-522
        • Van Stijn MFM
        • Korkic-Halilovic I
        • Bakker MSM
        • Van Der Ploeg T
        • Van Leeuwen PAM
        • Houdijk APJ
        Preoperative nutrition status and postoperative outcome in elderly general surgery patients: a systematic review.
        J Parenter Enter Nutr. 2013; 37: 37-43
        • Haydock DA
        • Hill GL.
        Impaired wound healing in surgical patients with varying degrees of malnutrition.
        J Parenter Enter Nutr. 1986; 10 (Available at:): 550-554
        • Fingar KR
        • Weiss AJ
        • Barrett ML
        • Elixhauser A
        • Steiner CA
        • Guenter P
        • Brown MH
        All-cause readmissions following hospital stays for patients with malnutrition, 2013: Statistical Brief #218.
        Healthcare Cost and Utilization Project. 2016; (Available at:)
        • Elixhauser A
        • Steiner C
        • Harris DR
        • Coffey RM
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36 (Available at:): 8-27
        http://www.ncbi.nlm.nih.gov/pubmed/9431328
        Date accessed: October 4, 2019
        • Royston P
        PTREND: Stata Module for Trend Analysis for Proportions.
        2014 (Available at:)
        • Elia M
        Screening for malnutrition: a multidisciplinary responsibility. Development and use of the Malnutrition Universal Screening Tool (‘MUST’) for adults.
        Redditch:BAPEN. 2003; (Available at:)
        • 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 (Available at:): 321-336
        • Guigoz Y
        • Vellas B
        • Garry PJ
        Assessing the nutritional status of the elderly: the mini nutritional assessment as part of the geriatric evaluation.
        Nutr Rev. 2009; 54 (Available at:): S59-S65
        • Kaiser MJ
        • Bauer JM
        • Ramsch C
        • Uter W
        • Guigoz Y
        • Cederholm T
        • Thomas DR
        • Anthony P
        • Charlton KE
        • Maggio M
        • Tsai AC
        • Grathwohl D
        • Vellas B
        • Sieber CC
        • MNA-International Group.
        Validation of the Mini Nutritional Assessment Short-Form (MNA-SF): a practical tool for identification of nutritional status.
        J Nutr Health Aging. 2009; 13 (Available at:): 782-788
        http://www.ncbi.nlm.nih.gov/pubmed/19812868
        Date accessed: October 16, 2019
        • Detsky A
        • McLaughlin Baker J
        • Johnston N
        • Whittaker S
        • Mendelson R
        • Jeejeebhoy K
        What is subjective global assessment of nutritional status?.
        J Parenter Enter Nutr. 1987; 11 (Available at:): 8-13
        • Goldfarb M
        • Lauck S
        • Webb JG
        • Asgar AW
        • Perrault LP
        • Piazza N
        • Martucci G
        • Lachapelle K
        • Noiseux N
        • Kim DH
        • Popma JJ
        • Lefèvre T
        • Labinaz M
        • Lamy A
        • Peterson MD
        • Arora RC
        • Morais JA
        • Morin J-F
        • Rudski LG
        • Afilalo J
        Malnutrition and mortality in frail and non-frail older adults undergoing aortic valve replacement.
        Circulation. 2018; 138 (Available at:): 2202-2211
        • Butterworth CE
        The skeleton in the hospital closet.
        Nutr Today. 1974; 9 (Available at:): 4-8
        • Keusch GT
        The history of nutrition: malnutrition, infection and immunity.
        J Nutr. 2003; 133 (Available at:): 336S-340S
        • Mira JC
        • Brakenridge SC
        • Moldawer LL
        • Moore FA
        Persistent inflammation, immunosuppression and catabolism syndrome.
        Crit Care Clin. 2017; 33: 245-258
        • Chermesh I
        • Hajos J
        • Mashiach T
        • Bozhko M
        • Shani L
        • Nir R-R
        • Bolotin G
        Malnutrition in cardiac surgery: food for thought.
        Eur J Prev Cardiol. 2014; 21 (Available at:): 475-483
        • Torre M La
        • Ziparo V
        • Nigri G
        • Cavallini M
        • Balducci G
        • Ramacciato G
        Malnutrition and pancreatic surgery: prevalence and outcomes.
        J Surg Oncol. 2013; 107 (Available at:): 702-708
        http://doi.wiley.com/10.1002/jso.23304
        Date accessed: June 23, 2019
        • Tobert CM
        • Hamilton-Reeves JM
        • Norian LA
        • Hung C
        • Brooks NA
        • Holzbeierlein JM
        • Downs TM
        • Robertson DP
        • Grossman R
        • Nepple KG
        Emerging impact of malnutrition on surgical patients: literature review and potential implications for cystectomy in bladder cancer.
        J Urol. 2017; 198 (Available at:): 511-519
        • Merli M
        • Nicolini G
        • Angeloni S
        • Riggio O
        Malnutrition is a risk factor in cirrhotic patients undergoing surgery.
        Nutrition. 2002; 18 (Available at:): 978-986
        • Stoppe C
        • Goetzenich A
        • Whitman G
        • Ohkuma R
        • Brown T
        • Hatzakorzian R
        • Kristof A
        • Meybohm P
        • Mechanick J
        • Evans A
        • Yeh D
        • McDonald B
        • Chourdakis M
        • Jones P
        • Barton R
        • Tripathi R
        • Elke G
        • Liakopoulos O
        • Agarwala R
        • Lomivorotov V
        • Nesterova E
        • Marx G
        • Benstoem C
        • Lemieux M
        • Heyland DK
        Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery.
        Crit Care. 2017; 21 (Available at:): 131
        http://www.ncbi.nlm.nih.gov/pubmed/28583157
        Date accessed: October 19, 2019
        • Marik PE
        • Zaloga GP
        Immunonutrition in high-risk surgical patients.
        J Parenter Enter Nutr. 2010; 34 (Available at:): 378-386
        http://doi.wiley.com/10.1177/0148607110362692
        Date accessed: December 2, 2019
        • Havens JM
        • Columbus AB
        • Seshadri AJ
        • Olufajo OA
        • Mogensen KM
        • Rawn JD
        • Salim A
        • Christopher KB
        Malnutrition at intensive care unit admission predicts mortality in emergency general surgery patients.
        J Parenter Enter Nutr. 2016; 42 (Available at:)014860711667659
        http://doi.wiley.com/10.1177/0148607116676592
        Date accessed: October 16, 2019
        • Schaible UE
        • Kaufmann SHE
        Malnutrition and infection: complex mechanisms and global impacts.
        PLoS Med. 2007; 4 (Available at:): e115
        • Fock RA
        • Vinolo MAR
        • de Moura Sá Rocha V
        • de Sá Rocha LC
        • Borelli P
        Protein-energy malnutrition decreases the expression of TLR-4/MD-2 and CD14 receptors in peritoneal macrophages and reduces the synthesis of TNF-α in response to lipopolysaccharide (LPS) in mice.
        Cytokine. 2007; 40 (Available at:): 105-114
        • Ockenga J
        • Freudenreich M
        • Zakonsky R
        • Norman K
        • Pirlich M
        • Lochs H
        Nutritional assessment and management in hospitalised patients: Implication for DRG-based reimbursement and health care quality.
        Clin Nutr. 2005; 24 (Available at:): 913-919