術前の低栄養が術後看護必要度に及ぼす影響：後ろ向き観察研究

Effects of Preoperative Nutritional Status on Postoperative Severity and Degree of Medical/Nursing Needs：A Retrospective Observational Study

要旨

　重症度，医療・看護必要度（以下，看護必要度）B項目は患者の日常生活動作（activities of daily living：ADL）の自立度を評価する項目である。待機的に泌尿器科の腹部手術を受ける患者において，術前の低栄養が術後の看護必要度に与える影響を検討した。主要評価項目を簡易栄養評価（mini nutritional assessment short form：MNA-SF）で分類された栄養状態による術後5日目の看護必要度B項目とし，その関連因子を評価した。術前に低栄養がある患者は術後3日目から術後5日目まで低栄養がない患者に比べて看護必要度B項目の点数が高く，ADLの自立度が低かった。術後5日目の看護必要度B項目にはMNA-SF，術式，米国麻酔科学会の術前全身状態分類（ASA-PS），手術時間が関連していた。術前の栄養状態は泌尿器科で腹部手術を受けた患者の看護必要度B項目に関係していた。

　Item B in the severity and degree of medical and nursing needs（nursing need）can measure patient’s degree of independence in actives of daily living（ADL）. A high nursing care is needed with score indicating a low level of independence in ADL. We identified a cohort of patients hospitalized for elective urologic abdominal surgery, and investigated the impact of preoperative malnutrition on postoperative nursing needs.

　The primary outcome was nursing need item B on postoperative day 5, categorized by nutritional status；we also evaluated the associated factors. Nutritional status was assessed preoperatively using the Mini Nutritional Assessment Short Form（hereafter referred as MNA-SF）.

　Patients with preoperative malnutrition had higher nursing need item B scores than patients without malnutrition from day 3 to day 5 after surgery. The MNA-SF score, surgery type, ASA classification, and operation time were associated with nursing need item B scores on the 5th day after surgery. In conclusion, preoperative nutritional status was associated with nursing need item B scores in patients undergoing urologic abdominal surgery.