Introduction: Malnutrition is a known risk factor for adverse surgical outcomes, yet screening rates remain low in neurosurgical patients. The American Society for Parenteral and Enteral Nutrition recommends hospitals screen all admitted patients within 24 hours to identify those at nutritional risk, a Joint Commission requirement aimed at improving patient outcomes. This study investigates trends in malnutrition diagnoses and nutrition screening practices over a 23-year period in patients undergoing craniotomies.
Methods: We utilized data from the MarketScan database, including patients who underwent craniotomies from 2000 to 2022. Malnutrition diagnoses were identified through ICD-10 codes E40-E46 and ICD-9 codes 260-269. Nutrition screenings were captured using ICD-10 code Z13.21 and CPT codes 97802, 97803, and 97804. Chi-square trend tests were used to evaluate changes in malnutrition diagnosis rates over time, and t-tests were conducted to compare malnutrition rates between periods.
Results: From 2000 to 2022, 87,410 craniotomies were performed, with only 4 patients (0.005%) receiving documented nutrition screening. Malnutrition diagnoses increased significantly over time, with 135 cases (1.5%) diagnosed in 2000-2004 among 8,828 patients. In 2005-2009, among 22,132 patients, malnutrition diagnoses rose to 506 cases (2.3%). From 2010-2014, malnutrition diagnoses increased further to 1,285 cases (4.2%) among 30,486 patients, and nutrition screening was documented in 2 patients during this period. In 2015-2019, malnutrition diagnoses peaked at 1,164 cases (6.4%) among 18,268 patients, with 1 nutrition screening documented. In the final period, 2020-2022, among 10,025 patients, 516 (5.1%) were diagnosed with malnutrition, with 1 nutrition screening. Malnutrition diagnosis rates were significantly higher in later years (χ² trend test, p< 0.001), with an average of 233 cases per year from 2015-2019, compared to 27 cases per year from 2000-2004 (t-test, p< 0.001).
Conclusion : Malnutrition diagnoses in craniotomy patients have significantly increased over the last two decades, yet nutrition screening remains exceedingly rare. These findings underscore a substantial gap in preoperative care practices, highlighting an opportunity for enhanced screening protocols to potentially improve patient outcomes.
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