Financial and clinical implications of protein energy malnutrition on hospitalized patients with colorectal cancer: Trends from the National Inpatient Sample.

34 Background: Colorectal cancer is the third most common cancer worldwide. Newer treatment options have significantly improved quality of life in these patients, albeit with the potential for more adverse effects. Patients with colorectal cancer tend to have varying degrees of protein energy malnutrition (PEM) due to multiple reasons, including cancer-related cachexia, sarcopenia, and adverse effects of chemotherapy. Therefore, the impact of PEM on outcomes among patients with colorectal cancer needs further exploration. Methods: We utilized the 2020 National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified patients with colorectal cancer and PEM using appropriate ICD-10 diagnostic codes. We stratified patients with colorectal cancer based on the presence or absence of PEM. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of < 0.05 was considered statistically significant. The aim of this study was to investigate the impact of PEM on in-hospital mortality, hospital length of stay (LOS), and total hospitalization charges among patients with colorectal cancer. Results: We identified a total of 77130 hospitalized patients with colorectal cancer, of which 11.06% (8535/77130) had comorbid PEM. The overall in-hospital mortality among patients with colorectal cancer was 2.74% (2115/77130). Among those with concomitant PEM, the mortality rate was significantly higher at 8.03% (686/8535, p < 0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and level confounders, PEM was found to be an independent predictor of increased in-hospital mortality (adjusted OR 2.94; 95% (confidence interval [CI] 2.26-3.81; p < 0.001), longer LOS (coefficient 5.37 days; CI 4.84-5.90; p < 0.001), higher total hospitalization charge ($53844; CI $45188-$62499; p < 0.001), increased need for mechanical ventilation (adjusted OR 3.87; CI 2.96-5.06; p < 0.001), and increased need for renal replacement therapy (adjusted OR 2.20; CI 1.08-4.50; p = 0.029). Conclusions: Our analysis demonstrated that PEM was widely prevalent in hospitalized patients with colorectal cancer and was associated with significantly higher in-hospital mortality and longer length of hospitalization. PEM was also associated with a significantly higher cost of healthcare utilization, increased need for mechanical ventilation and renal replacement therapy. A proactive approach to promote nutritional assessment and early nutritional optimization is indicated. Further prospective studies are needed to better understand the impact of nutritional optimization on the financial burden as well as short and long-term outcomes in this patient population.