New screening tool helps ID heart surgery patients at risk of malnutrition

Simple risk score guides surgeons in providing nutrition support sooner and more aggressively


Chicago June 15, 2017

Patients who are at risk for malnutrition when undergoing heart surgery now can be more quickly and easily identified, leading to intervention and potentially better surgical outcomes, according to a study published online today in The Annals of Thoracic Surgery.

A team of researchers at Johns Hopkins Hospital (JHH) in Baltimore, MD developed the JHH Nutrition Score to identify the risk for malnutrition. Malnutrition resulting from inadequate calorie intake after surgery is associated with high morbidity and mortality, as well as delayed recovery, increased hospital stay, early readmission, decreased quality of life and increased health care costs.

Benefits of the JHH nutrition risk score are that it is easily calculable and highly predictive, the markers for the score are immediately available in the patient’s ICU admission chart and providing nutrition sooner to high risk heart patients may improve their outcomes.

“Days in the ICU can go by quickly before we realize patients are not getting the nutritional support they need to improve recovery,” said senior author Glenn Whitman, MD, of Johns Hopkins Hospital. “The nutrition risk score may heighten our sensitivity to patients who are most at risk for needing nutritional support, allowing them to receive intervention sooner than we might have done in the past.”

Dr. Whitman and his colleagues at JHH and Brigham and Women’s Hospital in Boston, Mass., identified 1,056 adult open heart surgery patients from their institutions in 2012. Among this cohort, 87 (8%) required postoperative nutritional support. The patients who required nutritional support were more likely than their counterparts to have diabetes and chronic obstructive pulmonary disease.

The JHH Nutrition Score is generated by seven variables, such as prior cardiac interventions, white blood cell count, and urgent/emergent operation status, that independently predicted the need for nutritional support. Each variable was given a number if it was abnormal, with higher total scores demonstrating increased need for nutritional support.

“The JHH risk score can be used as a screening tool to divide cardiac surgery admissions into low or high risk for needing nutrition support,” said Dr. Whitman. “By adding up the total point score, we can look at patients and determine how at risk they are for being unable to eat during the initial ICU period. If the patients are at high risk, and we know that, we can start nutrition sooner.”

The variables used for the JHH NS are “readily accessible,” all available immediately from the chart at the time of ICU admission, and the score is easily calculable and highly predictive, explained Dr. Whitman. In contrast, markers from other nutrition risk tools require more history and understanding of patients, so there are substantial limitations when applied to an ICU admission.

The researchers validated the JHH NS by applying the scores to 1,336 patients who underwent heart surgery in 2015 at their institutions. The scores strongly correlated to the 115 (8.6%) who required postoperative nutritional support.

“In using the JHH Nutrition Score to accurately identify the at-risk patients and then aggressively pursuing nutrition support, we may improve substantially upon their current poor outcomes,” said Dr. Whitman. “Individualized nutrition strategies, combined with the expertise of the nutrition support team and the clinical approach of the caregiver, may further enhance the management of these patients.”

---

Notes for editors
The article is "A Novel Risk Score to Predict the Need for Nutrition Support After Cardiac Surgery," by Ohkuma RE, Crawford TC, Brown PM, Grimm JC, Magruder JT, Kilic A, Suarez-Pierre A, Snyder S, Wood JD, Schneider E, Sussman MS, Whitman GJ (http://dx.doi.org/10.1016/j.athoracsur.2017.03.013). It appears in The Annals of Thoracic Surgery, published by Elsevier.

Find comprehensive medical information presented for patients by leading experts in cardiothoracic surgery at the STS Patient Website (ctsurgerypatients.org).

Copies of this paper are available to credentialed journalists upon request; please contact Jennifer Bagley at jbagley@sts.org or +1 312 202 5865.

About The Annals of Thoracic Surgery
The Annals of Thoracic Surgery is the official journal of STS and the Southern Thoracic Surgical Association. It has a 5-year impact factor of 4.104, the highest of any cardiothoracic surgery journal worldwide. Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 7,100 cardiothoracic surgeons, researchers, and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals progress science, advance healthcare and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 35,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Jennifer Bagley
Society for Thoracic Surgery
+1 312 202 5865
jbagley@sts.org