Impact of protein-energy malnutrition on inpatient mortality, healthcare cost and clinical outcomes among patients with head and neck cancer.

Abstract

11064 Background: Protein-energy malnutrition (PEM) is a critical issue among patients diagnosed with head and neck cancers (HNC), primarily due to the tumor's anatomical location, and treatment-related side effects. Here, we examine the impact of PEM on the clinical outcomes and healthcare costs among hospitalized patients with HNC. Methods: This retrospective cohort study was conducted using data from the National Inpatient Sample database. Data of adult patients admitted with a diagnosis of HNC from 2016 to 2020 were analyzed and stratified based on the presence of PEM. The primary outcome was inpatient mortality rate, secondary outcomes included length of hospitalization, total hospital charges and other medical outcomes. Results: A total of 729,095 patients with HNC were identified, of whom 174,000 (23.8%) had PEM, with a mean age of 65.5 years and whites (77%) being the predominant race. Among the 32,075 patients who died, 11,715 (4.4%) had PEM. PEM was associated with a higher risk of mortality (6.74% vs 3.67%; OR:1.84, 95%CI 1.73-1.95; P < 0.001). Patients with PEM had an increased length of hospitalization (8.9 vs 5.2 days; adjusted difference of 3.3 days; 95% CI 3.21-3.45; P < 0.001), and higher total hospital charges ($98,959 vs $71,449; adjusted difference of $27,715, 95% CI $23,864-27,565; P < 0.001). Additionally, the presence of PEM was associated with increased risk of several secondary outcomes including septic shock, intubation, acute kidney injury, pneumonia, blood transfusion, neutropenia and urinary tract infections compared to the non-PEM cohort. Conclusions: This study demonstrated a two-fold increased risk of mortality and a prolonged length of stay, with approximately $27,000 more total charges in malnourished patients with HNC compared to those without PEM. Prospective trials evaluating strategies to improve PEM, and provide adequate nutritional support are essential to enhance clinical outcomes, reduce mortality and decrease healthcare costs. Effect of PEM on clinical and healthcare outcomes among hospitalized patients with HNC. Outcomes HNC with PEM HNC without PEM Adjusted Odds Ratio 95% Confidence Interval P value Mortality 6.74% 3.67% 1.84 1.73-1.95 <0.001 Length of stay 8.9 5.2 3.33 3.21-3.45 <0.001 Total hospital charge 98,959 71,449 25,715 23,864-27,565 <0.001 Sepsis 10.89 5.08 2.20 2.09-2.30 <0.001 Intubation 15.87 10.01 1.61 1.54-1.68 <0.001 Pressors 1.68 1.03 1.61 1.40-1.86 <0.001 Acute kidney injury 16.89 11.82 1.42 137-1.48 <0.001 Pneumonia 13.97 8.84 01.65 1.58-1.72 <0.001 Neutropenia 4.67 2.5 1.86 1.73-2.00 <0.001 Urinary tract infection 5.70 4.15 1.42 1.34-1.51 <0.001 Blood transfusion 10.19 6.09 1.71 1.63-1.8 <0.001