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Cirurgia ortopédica e ortotraumatológica : factor de risco nutricional?
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A desnutrição associada à doença associa-se a perda de peso significativa e alterações fisiológicas e metabólicas, decorrentes ou não de insuficiente ingestão e aumento da metabolização de energia e nutrientes. Estima-se que cerca de 20 a 50% dos doentes estejam desnutridos na admissão ao hospital. Há décadas que se tem vindo a construir evidência sobre o impacto negativo tanto nos outcomes clínicos como cirúrgicos, sabendo-se que a desnutrição implica uma diminuição da capacidade funcional do doente, e contribui negativamente para o aparecimento de morbilidade infecciosa, o tempo de internamento do doente, a mortalidade e outros indicadores importantes, aumentando custos na área da saúde. Este projecto de investigação clínica teve como objectivo avaliar o risco e estado nutricionais em 23 doentes internados no Serviço de Ortopedia do Hospital Universitário de Santa Maria – Centro Hospitalar de Lisboa Norte. Para avaliação do risco nutricional foi utilizado o Malnutrition Universal Screening Tool (MUST) e para avaliação do estado nutricional, o Subjective Global Assessment (SGA), o Índice de Massa Corporal (IMC), a Prega Cutânea Tricipital (PCT) e o Perímetro do Braço (PB). No global, 100% dos doentes apresentava risco de desnutrição, sendo que 39% tinha elevado risco de desnutrição. Apenas 30% dos doentes tinham um estado nutricional adequado. Um maior risco nutricional e estados de desnutrição moderada associaram-se a maior incidência de complicações infecciosas. A prevalência tanto de risco nutricional como de estados de desnutrição per se assume valores elevados em meio hospitalar. Torna-se por isso essencial sensibilizar os Profissionais de Saúde para a importância da avaliação do risco e estado nutricionais no internamento, bem como o reconhecimento precoce da desnutrição, de forma a promover uma correcta referenciação para intervenção, acompanhamento e monitorização nutricionais especializados e individualizados.
Disease associated malnutrition is linked to significate weight loss and physiological and metabolic changes, resulting of insufficient feeding, or not, and increased energy and nutrient metabolism. On hospital admission, it’s estimated that 20 to 50% of patients suffer from malnutrition. For some decades now, there has been a growing evidence about its negative effect on clinical and surgical outcomes, and we now know that malnutrition involves a decrease in functional capacity, and negatively impacts the incidence of infectious morbidity, length of hospital stay, mortality and other important factors, raising costs in the healthcare sector. This clinical research project’s goal was to assess the nutritional risk and status of 23 patients admitted to the Orthopaedics Department of a University Hospital (Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte). We used Malnutrition Universal Screening Tool (MUST) to assess nutritional risk, and Subjective Global Assessment (SGA), Body Mass Index (BMI), arm circumference and triceps skinfold thickness for nutritional status assessment. In general, 100% of patients was at risk of malnutrition, with 39% at a high risk for malnutrition. Only 30% of patients presented an adequate nutritional status. A greater nutritional risk and malnutrition score was linked to greater incidence of infectious complications. The prevalence of nutritional risk and malnutrition statuses per se take on large numbers in the healthcare environment. Therefore it’s essential to raise awareness on healthcare professionals on the importance of assessing nutritional risk and status during hospital stay, as well as early recognition of undernutrition so that there can be an accurate forwarding of patients to specialized and individualized nutritional intervention, accompaniment and monitoring.
Disease associated malnutrition is linked to significate weight loss and physiological and metabolic changes, resulting of insufficient feeding, or not, and increased energy and nutrient metabolism. On hospital admission, it’s estimated that 20 to 50% of patients suffer from malnutrition. For some decades now, there has been a growing evidence about its negative effect on clinical and surgical outcomes, and we now know that malnutrition involves a decrease in functional capacity, and negatively impacts the incidence of infectious morbidity, length of hospital stay, mortality and other important factors, raising costs in the healthcare sector. This clinical research project’s goal was to assess the nutritional risk and status of 23 patients admitted to the Orthopaedics Department of a University Hospital (Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte). We used Malnutrition Universal Screening Tool (MUST) to assess nutritional risk, and Subjective Global Assessment (SGA), Body Mass Index (BMI), arm circumference and triceps skinfold thickness for nutritional status assessment. In general, 100% of patients was at risk of malnutrition, with 39% at a high risk for malnutrition. Only 30% of patients presented an adequate nutritional status. A greater nutritional risk and malnutrition score was linked to greater incidence of infectious complications. The prevalence of nutritional risk and malnutrition statuses per se take on large numbers in the healthcare environment. Therefore it’s essential to raise awareness on healthcare professionals on the importance of assessing nutritional risk and status during hospital stay, as well as early recognition of undernutrition so that there can be an accurate forwarding of patients to specialized and individualized nutritional intervention, accompaniment and monitoring.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Desnutrição hospitalar Risco nutricional Estado nutricional Malnutrição Doentes cirúrgicos MUST