The effect of medical nutrition therapy on health expenditures and health indicators in patients undergoing hip and knee arthroplasty surgery

In this study, it was aimed to determine the effect of protein-rich medical nutrition therapy on health expenditures and health indicators in patients undergoing hip and knee arthroplasty surgery. The study was carried out on 41 patients aged 65 and over, who had undergone hip and knee arthroplasty surgery at the Orthopedics Department of Ufuk University Dr. Rıdvan Ege Education Health Research Hospital between October 2018 and March 2019. Information about all patients included in the study (age, gender, history of co-morbidity disease, drug use, infection status in the last 10 days, anthropometric measurements, etc.) was obtained from patient files, Nutritional Risk Score-2002 (NRS-2002) and Mini-Nutritional Assessment (MNA) nutritional screening tests were performed by a dietitian at hospital admission. Anthropometric measurements of the patients [height, body weight, upper middle arm circumference (UMAC), knee length], Body Mass Index values, hand grip strength measurements were recorded by the dietitian at the 1st and 6th weeks postoperatively. Food consumption records were taken while in the hospital, with 24-hour food consumption records at the 3rd and 6th weeks. The blood biochemical findings of the patients [albumin, fasting plasma glucose, AST, ALT, blood urea nitrogen, creatinine, sedimentation, CRP, total lymphocyte count, sodium, potassium] before and after surgery (1 week, 3 weeks , 6 weeks) were recorded from patient files. Information on health expenditures was also obtained from the institutional and billing unit of the hospital. The patients are 71% between of 65-73 years old, 17% are 74-84 years old, 12% are 85 years old and over. Of the 41 patients included in the study, 20 received nutritional support in hydroxy methyl butyrate, vitamin D, protein rich, hypercaloric and 21 did not receive nutritional support. Of the patients who received nutritional support, 55% had hip replacement, 25% had hip replacement revision, 20% had knee replacement surgery, 38.1% of the patients who did not receive nutritional support had hip replacement, 4.8% had hip replacement revision, 52.4% knee prosthesis, 4.8% had undergone knee prosthesis revision surgery. According to MNA, 4 male and 17 female patients were in normal nutritional status, 2 male and 11 female patients were at risk of malnutrition, and 3 male and 4 female patients had malnutrition; According to NRS-2002, it was defined that 3 male and 22 female patients had a nutritional risk, and 6 male and 10 female patients had no nutritional risk. While the difference between the hand grip strength and body weight values of the patients before and at the 6th week after surgery was statistically significant (p<0.05), the difference between UMAC and BMI was not statistically significant (p>0.05). It was determined that the serum albumin and total lymphocyte cell levels of the patients who received nutritional support increased moderately at the 6th week postoperatively. Serum albumin levels were found to be statistically different between the groups of patients who received and did not receive nutritional support and between the periods of surgery (p<0.05). In this study, providing nutritional support and nutrition education led to an increase in the patients' food intake and higher dietary energy and protein intakes (p<0.05). According to the results of the study, taking oral enteral nutritional support of the patients was beneficial in meeting their optimal nutritional needs.