Financial and nutrition outcomes for patients placed on enteral nutrition versus oral intake

Abstract

The objective of this study was to determine if providing either enteral nutrition or oral nutrition to patients influenced nutritional parameters, length of stay (LOS) and cost. All patients who received enteral nutrition support between January 1, 1997 to December 31, 1999 at Scott & White Memorial Hospital in Temple, TX were evaluated in a retrospective chart review. Malnutrition- and disease-matched patients who received oral nutrition support were selected from the hospital's patient database. Of a total of 276 patients; 189 received enteral nutrition and 87 received oral nutrition. Admission and discharge laboratory values, functional ability, LOS, total medical expenses, and pharmaceutical expenses were compared between groups. Statistical analyses included Student's t-test, Chi-Square, and the General Linear Model. Results included the following: at admission enteral nutrition patients weighed significantly more (P < 0.001) and had an increased body mass index (BMI) (P < 0.01) compared to oral nutrition patients. Change between admission and discharge parameters related to nutrition were not significantly different between the two groups. Values at discharge for prealbumin, albumin, and total lymphocyte count were within ranges considered malnourished as they had been at admission. Initial financial analysis indicated that enteral nutrition patients had a significantly longer LOS and greater medical expenses. Both groups of surgical patients had increased total cost (P < 0.001 and P < 0.01 for enteral and oral nutrition groups, respectively) as compared to medical patients. Additionally, the enteral and oral nutrition groups were not significantly different for LOS or medical expenses for head and neck cancer patients receiving radiation treatment or chemotherapy. Results of this study have demonstrated several points. First, appropriate nutrition intervention, both through enteral or oral nutrition, may maintain a patient's nutritional status; and even if outcomes are not significantly improved, nutrition support may prevent further nutritional decline during the hospital stay. Secondly, based on laboratory values, patients may not have made a full nutritional recovery by discharge. Finally, malnourished head and neck cancer patients should receive nutrition intervention based on individual needs; according to our data, providing enteral nutrition does not increase LOS or medical expenses.