Identifying Malnourishment in Geriatric Patients With Nutritional Screenings to Improve Surgical Outcomes

The elderly are considered to be a higher surgical risk and tend to have more serious comorbidities that can increase the risk of complications in the postoperative period. Nutritional status in the elderly has been determined to be a strong predictor of poor outcomes, especially in patients with hip fractures. Research has demonstrated a relationship between low nutritional status scores, low serum albumin levels, and poor surgical outcomes including a higher incidence of mortality within one month postoperatively in those undergoing hip surgery alone. With an estimated 2/3 of the elderly population at risk for malnutrition remaining undiagnosed by those providing care to this population, preoperative functional and nutritional assessment and optimization is needed prior to surgery to minimize surgical risks. Hospital length of stays for those malnourished were noted to be approximately 2 weeks longer at 34 days compared to 20 days for those adequately nourished and 26 days for those considered to be at risk for malnutrition. Nutritional optimization can improve patient outcomes and improve quality of life by decreasing the risks of surgical complications, decreased mobility postoperatively, and a loss of independence. The purpose of this project is to determine if surgical outcomes are influenced by geriatric patients identified as malnourished or at risk of malnourishment by pre-operative screening with the Mini-Nutritional Assessment (MNA) tool. The patient population will consist of geriatric patients aged 65 years and older presenting for preoperative assessment for surgical procedures. This quality improvement study will investigate if preoperative screening for malnutrition using the MNA tool, identifies a significant number of this population at risk for malnutrition, compared to those not at risk for malnutrition. In this study we will determine if the MNA tool is adequately capturing those at risk for malnutrition, and if identifying these patients and the surgical team of their nutritional status, influences surgical outcomes in regards to postoperative complications, prolonged hospital length of stay and mortality rates. This project is pending UAB Institutional Review Board QI designation.