Effects of malnutrition on in-hospital outcomes among young adults hospitalized with gastrointestinal cancers: A multicentric retrospective cohort study.

Abstract

e16490 Background: Protein–energy malnutrition (PEM) is common in gastrointestinal (GI) cancers and may worsen inpatient outcomes. Contemporary national data describing the impact of PEM among young adults with GI malignancies are limited. Methods: We conducted a retrospective cohort study using the all-payer database of HCUP-NIS between 2018–2021. Young adults aged 18–39 years hospitalized with GI cancers were identified using ICD-10-CM malignant neoplasm codes C15–C26. PEM was identified using diagnosis codes for protein–energy malnutrition. Outcomes included in-hospital mortality, length of stay (LOS), total hospital charges, and discharge disposition. Survey-weighted analyses incorporating NIS discharge weights, hospital clustering, and stratification were used to generate national estimates. Multivariable survey-weighted logistic regression used to evaluate mortality and discharge disposition; multivariable survey-weighted linear regression evaluated LOS and charges, adjusting for age, sex, race/ethnicity, primary payer, ZIP-income quartile, elective status, calendar year, and age-adjusted Charlson Comorbidity Index. Results: The study included 58,910 weighted hospitalizations of young adults with GI cancers, of whom 11,915 (20.2%) had PEM. Compared with patients without PEM, those with PEM had higher comorbidity burden and acuity, including higher prevalence of metastatic disease (71.8% vs 53.1%). PEM was also associated with higher odds of in-hospital death (aOR 2.11 p < 0.001. Discharge disposition also differed by PEM status; admissions with PEM had lower odds of discharge to home/home health versus non-home discharge (aOR 0.60; 95% CI 0.53–0.68; p < 0.001). Unadjusted outcomes were worse among PEM admissions, including higher in-hospital mortality (8.4% vs 3.2%), longer LOS (10.43 vs 5.63 days), and higher total charges ($133,790 vs $83,702). In adjusted analyses, absence of PEM (No PEM) was associated with substantially lower inpatient resource utilization: LOS was 4.49 days shorter (β −4.492; SE 0.248; p < 0.001) and total charges were $53,513 lower (β −$53,512.6; SE $5,527.6; p < 0.001) compared with PEM. Conclusions: Among young adults hospitalized with GI cancers, PEM was present in approximately one in five admissions and was independently associated with markedly higher in-hospital mortality, longer LOS, and substantially higher hospital charges. These findings support routine inpatient nutritional risk screening and early nutrition-directed interventions as potential targets to improve outcomes and reduce resource utilization in this high-risk population.