Impact of a randomized, controlled trial of liberal vs conservative hospital discharge criteria on energy, protein, and fluid intake in patients who received marrow transplants

Object: To determine if adult patients who received marrow transplants had faster resumption of oral energy and nutrient intake and shorter duration of intravenous (IV) fluid requirement if discharged from the hospital earlier than is customary. Design: Randomized, controlled trial of patients remaining hospitalized because of inadequate oral intake. Consenting patients were assigned randomly to remain hospitalized (hospital group) or be discharged to an ambulatory setting (ambulatory group). Subjects: Seventy-eight patients of the Fred Hutchinson Cancer Research Center who were consuming less than 33% of estimated energy requirement and requiring up to 3,000 mL of fluids per day intravenously. Intervention: Participants received nutrition counseling by a registered dietitian to promote resumption of oral intake. Daily oral intake records were analyzed to determine energy and nutrient content. Main outcome measures: Days after study enrollment to consume 33% of energy and protein requirements and total number of days of IV fluid support were analyzed by group until discharge from the center, approximately 100 days after transplantation. Statistical analyses: Demographic data were defined by group means. Differences between treatment procedures were determined by Cox regression analysis. No variables were confounding. Results: The hospital group took fewer days than the ambulatory group to resume oral energy intake (4.5 vs 8.0, P=.004) and to discontinue IV fluids (30.5 vs 48.5, P=.019). There was no difference between groups in days of parenteral nutrition support (P=.817) or days to resume oral protein intake (P=.470). Applications/conclusions: Oral and gastrointestinal complications delay resumption of oral energy and protein intakes after transplantation. Earlier hospital discharge can achieve cost savings but may delay resumption of oral energy intake. Because of continued high-risk nutrition status and potential for rapid change in medical status, nutrition assessment and counseling are necessary in both the hospital and ambulatory setting to promote resumption of oral intake and discontinuation of IV fluids.