Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Clinical Nutrition

Financial impact of sarcopenia on hospitalization costs

European Journal of Clinical Nutrition volume 70, pages 1046–1051 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

This study aims to increase knowledge regarding the association of sarcopenia with hospitalization costs among a wide-ranging sample of adult hospitalized patients.

Subjects/Methods:

A prospective study was conducted among hospitalized adult patients. Sarcopenia was identified according to the European Working Group on Sarcopenia in Older People, as low muscle mass, assessed by bioelectrical impedance analysis and low muscle function evaluated by handgrip strength. Hospitalization cost was calculated for each patient based on discharge diagnosis-related group codes and determined on the basis of a relative weight value. Costs were defined as the percentage of deviation from the cost of a patient with a relative weight equal to one. Multivariable linear regression models were performed to identify the factors independently associated with hospitalization costs.

Results:

A total of 656 hospitalized patients aged ⩾18 years (24.2% sarcopenic) composed the study sample. Sarcopenia increased hospitalization costs by €1240 (95% confidence interval (CI): €596–1887) for patients aged <65 years and €721 (95% CI: €13–1429) for patients aged ⩾65 years. Sarcopenic overweight was related to an increase in hospitalization costs of €884 (95% CI: €295–1476).

Conclusions:

Sarcopenia is independently related to hospitalization costs. This condition is estimated to increase hospitalization costs by 58.5% for patients aged <65 years and 34% for patients aged ⩾65 years.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423.

    Article  Google Scholar 

  2. Janssen I, Heymsfield SB, Ross R . Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002; 50: 889–896.

    Article  Google Scholar 

  3. Abellan van Kan G . Epidemiology and consequences of sarcopenia. J Nutr Health Aging 2009; 13: 708–712.

    Article  CAS  Google Scholar 

  4. Volpato S, Bianchi L, Cherubini A, Landi F, Maggio M, Savino E et al. Prevalence and clinical correlates of sarcopenia in community-dwelling older people: application of the EWGSOP definition and diagnostic algorithm. J Gerontol A Biol Sci Med Sci 2014; 69: 438–446.

    Article  CAS  Google Scholar 

  5. Cherin P, Voronska E, Fraoucene N, de Jaeger C . Prevalence of sarcopenia among healthy ambulatory subjects: the sarcopenia begins from 45 years. Aging Clin Exp Res 2014; 26: 137–146.

    Article  Google Scholar 

  6. Gariballa S, Alessa A . Sarcopenia: prevalence and prognostic significance in hospitalized patients. Clin Nutr 2013; 32: 772–776.

    Article  Google Scholar 

  7. Smoliner C, Sieber CC, Wirth R . Prevalence of sarcopenia in geriatric hospitalized patients. J Am Med Dir Assoc 2014; 15: 267–272.

    Article  Google Scholar 

  8. Cerri AP, Bellelli G, Mazzone A, Pittella F, Landi F, Zambon A et al. Sarcopenia and malnutrition in acutely ill hospitalized elderly: prevalence and outcomes. Clin Nutr 2015; 34: 745–751.

    Article  Google Scholar 

  9. Sousa AS, Guerra RS, Fonseca I, Pichel F, Amaral TF . Sarcopenia among hospitalized patients - a cross-sectional study. Clin Nutr 2015; 34: 1239–1244.

    Article  Google Scholar 

  10. Rossi AP, Fantin F, Micciolo R, Bertocchi M, Bertassello P, Zanandrea V et al. Identifying sarcopenia in acute care setting patients. J Am Med Dir Assoc 2014; 15: 303 e7–303 12.

    Article  Google Scholar 

  11. Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E et al. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr 2012; 31: 652–658.

    Article  Google Scholar 

  12. Otsuji H, Yokoyama Y, Ebata T, Igami T, Sugawara G, Mizuno T et al. Preoperative sarcopenia negatively impacts postoperative outcomes following major hepatectomy with extrahepatic bile duct resection. World J Surg 2015; 39: 1494–1500.

    Article  Google Scholar 

  13. Joglekar S, Asghar A, Mott SL, Johnson BE, Button AM, Clark E et al. Sarcopenia is an independent predictor of complications following pancreatectomy for adenocarcinoma. J Surg Oncol 2014; 111: 771–775.

    Article  Google Scholar 

  14. Du Y, Karvellas CJ, Baracos V, Williams DC, Khadaroo RG . Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery. Surgery 2014; 156: 521–527.

    Article  Google Scholar 

  15. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE . Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 2012; 107: 931–936.

    Article  CAS  Google Scholar 

  16. Vetrano DL, Landi F, Volpato S, Corsonello A, Meloni E, Bernabei R et al. Association of sarcopenia with short- and long-term mortality in older adults admitted to acute care wards: results from the CRIME study. J Gerontol A Biol Sci Med Sci 2014; 69: 1154–1161.

    Article  Google Scholar 

  17. Thomas DR . Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia. Clin Nutr 2007; 26: 389–399.

    Article  Google Scholar 

  18. Beaudart C, Rizzoli R, Bruyere O, Reginster JY, Biver E . Sarcopenia: burden and challenges for public health. Arch Public Health 2014; 72: 45.

    Article  Google Scholar 

  19. Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R . The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc 2004; 52: 80–85.

    Article  Google Scholar 

  20. Sheetz KH, Waits SA, Terjimanian MN, Sullivan J, Campbell DA, Wang SC et al. Cost of major surgery in the sarcopenic patient. J Am Coll Surg 2013; 217: 813–818.

    Article  Google Scholar 

  21. Friedman J, Lussiez A, Sullivan J, Wang S, Englesbe M . Implications of sarcopenia in major surgery. Nutr Clin Pract 2015; 30: 175–179.

    Article  Google Scholar 

  22. Kirk PS, Friedman JF, Cron DC, Terjimanian MN, Wang SC, Campbell DA et al. One-year postoperative resource utilization in sarcopenic patients. J Surg Res 2015; 30: 074.

    Google Scholar 

  23. ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 2002; 26 (1 Suppl), 1SA–138SA.

    Google Scholar 

  24. Hodkinson HM . Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1972; 1: 233–238.

    Article  CAS  Google Scholar 

  25. Katz S . Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 1983; 31: 721–727.

    Article  CAS  Google Scholar 

  26. Charlson ME, Pompei P, Ales KL, MacKenzie CR . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.

    Article  CAS  Google Scholar 

  27. Ottery F . Patient-generated subjective global assessment. In: McCallum P, Polisena C. (eds). The Clinical Guide to Oncology Nutrition. The American Dietetic Association: Chicago, IL, USA, 2000, pp 11–23.

    Google Scholar 

  28. Marfell-Jones M, Olds T, Stewart A, Carter L . International Standards for Anthropometric Assessement. ISAK: Potchefstroom, South Africa, 2006.

    Google Scholar 

  29. Janssen I, Heymsfield SB, Baumgartner RN, Ross R . Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 2000; 89: 465–471.

    Article  CAS  Google Scholar 

  30. Fess E . Grip strength. In: Casanova J (ed) Clinical Assessment Recommendations. American Society of Hand Therapists: Chicago, IL, USA, 1992, pp 41–45.

    Google Scholar 

  31. Vaz M, Thangam S, Prabhu A, Shetty PS . Maximal voluntary contraction as a functional indicator of adult chronic undernutrition. Br J Nutr 1996; 76: 9–15.

    Article  CAS  Google Scholar 

  32. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995; 854: 1–452.

  33. Portaria n.º 839- A/2009. Diário da República. Portugal, 2009.

  34. Portaria n.º 163/2013. Diário da República. Portugal, 2013.

  35. Portaria nº 20/2014. Diário da República. Portugal, 2014.

  36. Direção-Geral da Saúde. Direção de Serviços de Informação e Análise/Divisão de Estatísticas da Saúde e Monitorização. Centros de Saúde e Unidades Hospitalares. Recursos e Produção. Portugal, 2012.

  37. Guerra RS, Amaral TF, Sousa AS, Pichel F, Restivo MT, Ferreira S et al. Handgrip strength measurement as a predictor of hospitalization costs. Eur J Clin Nutr 2015; 69: 187–192.

    Article  CAS  Google Scholar 

  38. Freijer K, Tan SS, Koopmanschap MA, Meijers JM, Halfens RJ, Nuijten MJ . The economic costs of disease related malnutrition. Clin Nutr 2013; 32: 136–141.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Centro Hospitalar do Porto and all ward directors for facilitating the data collection. RSG received a scholarship from Fundação para a Ciência e a Tecnologia, financing program POPH/FSE, under the project SFRH/BD/61656/2009.

Author information

Authors and Affiliations

  1. Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal

    A S Sousa & T F Amaral

  2. Departamento de Bioquímica da Faculdade de Medicina, Universidade do Porto, Porto, Portugal

    R S Guerra

  3. UISPA-INEGI, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal

    R S Guerra & T F Amaral

  4. Serviço de Nutrição e Alimentação, Centro Hospitalar do Porto, Porto, Portugal

    I Fonseca & F Pichel

  5. Centro Hospitalar do Porto, Porto, Portugal

    S Ferreira

Authors
  1. A S Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R S Guerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I Fonseca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F Pichel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T F Amaral
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A S Sousa.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sousa, A., Guerra, R., Fonseca, I. et al. Financial impact of sarcopenia on hospitalization costs. Eur J Clin Nutr 70, 1046–1051 (2016). https://doi.org/10.1038/ejcn.2016.73

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2016.73

This article is cited by

Search

Advanced search

Quick links