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At the same time, malnutrition causes an imbalance in the gut microbiota, with a reduction in beneficial bacteria (lactobacilli, bifidobacteria) increasing the risk of postoperative cognitive impairment, and surgical anesthesia exacerbates the ecological imbalance of the gut microbiota, shifting it toward a more toxic phenotype (91)

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Consistent with our methods in previous years for formulating this estimate, we are applying the IPPS market basket percentage increases for FYs 2022 through 2024 to the applicable estimated reasonable cost amount (previously described) in order to model the estimated FY 2024 reasonable cost amount under the demonstration