Hospital Discharge on Enteral Nutrition is Associated with Increased Hospital Readmissions

Abstract

Background: Enteral nutrition (EN) delivered via an enteric access device is employed to correct severe malnutrition and feed patients with pathology restricting oral intake, and is often initiated in the hospital. There are limited data on the clinical outcomes of patients discharged from the hospital on EN. We sought to assess whether discharge with enteral nutrition (DCEN) was independently associated with increased hospital readmissions and to assess the frequency of DCEN in our hospital.

Methods: We conducted a retrospective cohort study of all hospital discharges from a tertiary care hospital between 7/2017 and 12/2019. The primary and secondary outcomes were 30- and 90-day readmissions respectively. We evaluated demographic and clinical characteristics of patients, nutrition status, and readmissions as reported in the electronic health record per hospital encounter. Logistic regressions were performed for 30- and 90-day readmissions based on DCEN.

Results: Of 80,080 hospital encounters, 2527 (3.2%) encounters resulted in discharge with EN. 30-day readmissions occurred in 22.8% of encounters with DCEN and 12.5% of encounters without (p < 0.001). 90-day readmissions occurred in 35.1% and 20.4% of encounters with and without DCEN respectively (p < 0.001). The unadjusted odds ratio for 30-day readmissions for encounters with DCEN was 2.07 (CI 1.88–2.28). When adjusted for age, race, sex, Charlson Comorbidity Index, and malnutrition co-diagnosis, the odds ratio was 1.40 (CI 1.27–1.55).

Conclusions: Patients with DCEN have a significantly higher likelihood of 30- and 90-day readmission. Targeted interventions and improved post-discharge care for this identified high-risk population may decrease hospital readmissions.

Highlight

Retrospective cohort study of all hospital discharges from a tertiary care hospital over 2.5 years concludes that patients with discharge on enteral nutrition have a significantly higher likelihood of 30- and 90-day readmission compared to those without.

Keywords:

• Enteral nutrition
• hospital discharge
• hospital readmissions
• nutritional support
• transitions of care

Acknowledgements

We thank Afshin Parsikia, Charlene Compher and James D. Lewis for their contributions. Sonali Palchaudhuri is supported by NIDDK grant T32-DK007740. An abstract involving elements of this manuscript was presented at Digestive Diseases Week 2021.

Authors’ contribution

Sonali Palchaudhuri, Shivan Mehta, and Octavia Pickett-Blakely contributed to conception/design of the research; Sonali Palchaudhuri, Christopher Snider, Lauren Hudson, Gary Wu, Shivan Mehta, and Octavia Pickett-Blakely contributed to acquisition, analysis, or interpretation of the data; Sonali Palchaudhuri drafted the manuscript; all listed authors critically revised the manuscript; and Sonali Palchaudhuri agrees to be fully accountable for ensuring the integrity and accuracy of the work. All authors read and approved the final manuscript.