A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions

The adverse effects of disease-related malnutrition (DRM) on health care use and costs are well substantiated. However, the impact of managing DRM with nutritional support on health care use, including hospital (re)admissions requires exploration. This systematic review (9 RCT, N=1190) examined the effects of oral nutritional supplements (ONS) on hospital (re)admissions. Meta-analysis of 6 RCT (N=852) with data on the proportion of patients (re)admitted to hospital showed significant reductions with ONS vs. routine care (OR 0.59, 95% Cl 0.43-0.80,P=0.001), including 5 RCT (N=826) that recorded readmissions (OR 0.59, 95% CI 0.43-0.80, P=0.001). The significant reduction in (re)admissions was found in meta-analyses of ONS trials in various settings and in patients with DRM or of varied nutritional status. A larger meta-analysis (8 RCT, N=999) that combined other (re)admissions data using standardised differences also showed a significant reduction with ONS (effect size -0.23, 95% Cl -0.36 to -0.10, P=0.001). Most of these trials (75%) were in older people aged >= 65 years (6 RCT, N=834, effect size -0.18,95% CI -0.31 to -0.04, P=0.011). This systematic review shows that ONS significantly reduce hospital (re)admissions, particularly in older patient groups, with economic implications for health care. (C) 2013 Elsevier B.V. All rights reserved.