Introduction Patients, admitted to a surgical ward who have undergone a prolonged pre-admission illness are likely to have some element of malnutrition. This may be compounded by surgical procedures (and subsequent fasting) after admission and these patients can go into severe malnutrition quickly, often before the treating team realises it. The presence of malnutrition in a surgical patient has a direct bearing on the overall outcome during hospitalisation. A nutritionally deprived patient is unable to mount an adequate response against infection and the surgical outcome is hence likely to be sub-optimal. Complications such as intestinal anastomosis leakage, wound dehiscence and overwhelming sepsis are more common in patients with malnutrition. The British Society of Gastroenterology has recognised that such patients are common in UK hospitals and on average their length of stay is almost doubled. This had led to the development of comprehensive guidelines regarding enteral feeding in adult hospitalised patients. The aim of the present study was to compare current practice in a district general hospital to the BSG guidelines.
Methods A cross-sectional observational study of inpatients on general surgical wards over a 24-h period was performed. Medical and nursing notes were reviewed and data recorded regarding nutritional assessment and management.
Results 72 patients were assessed over a 24-h period. Patients were divided into three groups, A elective surgery, B emergency surgery and C acute non-operative admission. Nutritional assessments were carried out on all patients, however BMI was not recorded in any. Pre admission nutritional intake was recorded in 61 (85%) patients. Data from these 61 patients were analysed to determine period of starvation. The median number of days between starvation and commencement of nutritional support was three (range 0–7), 6 (0–11) and 5 (0–12) respectively.
Conclusion This study has shown that many of the patients on a general surgical ward have a significant period of starvation prior to and during their admission. While a nutritional assessment was performed in all patients, BMI and thus assessment of malnourishment as advocated by the BSG guidelines was not recorded in any patient. The nutritional needs of elective surgical patients appears to be well met in our hospital (median time to feeding 3 days) when compared to the BSG guidelines (3–5 days). Emergency admissions, however, were not as well managed with many waiting up to 1 week before nutritional support was instigated. Adequate assessment of nutritional status is important in all surgical patients, this is equally important for both patients undergoing surgery and those who do not require any surgical intervention.
Competing interests None declared.
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