Kate Woodhead RGN DMS has warned that insufficient attention is paid to the consequences of dietary intake, for patients undergoing surgery. In the January edition of The Clinical Services Journal, she highlights the need to assess and manage patients' nutrition to improve surgical outcomes.
One aspect of surgical assessment and practice is an understanding of the impact of the surgery on wound healing and post-operative recovery. When an elective surgical patient is called to pre-assessment, it indicates that the day for surgery is not far away. What is often missing from the assessment is an evaluation of the patient for malnutrition or under-nutrition. Many patients who present for pre-assessment may be malnourished, indeed, anecdotally, around 50% of all patients lack an appropriate diet.
Kate Woodhead points out, in the latest edition of The Clinical Services Journal, that the elderly are at particularly high risk and states that clinicians need to establish whether patients have lost weight recently, had diarrhoea regularly, lost their appetite, or other aspects of nutritional health, which may be able to be corrected before the surgery takes place. Many patients do not receive any kind of risk assessment or nutritional guidance. There is, however, a growing body of evidence to suggest that supporting a patient’s nutritional needs may lead to better surgical outcomes and reduce the length of stay.
Research has identified that malnutrition is a modifiable risk for surgery. A meta analysis of 15 RCTs demonstrated that across a variety of different surgical procedures that nutritional support was significantly more effective than the control group at decreasing the incidence of infectious complications, non-infectious complications and shortening the length of hospital stay.1
Kate Woodhead says it is essential that access to effective screening tools is enabled, so that patients who present for pre-assessment for surgery can be risk assessed and individualised care plans to meet their pre-surgical nutritional needs can be put into place. Whether this is a full prehabilitation programme or merely appropriate nutritional support will need to be a multidisciplinary team decision, supported by the hospital. She provides an insight into current best practice and calls for improvement across all NHS Trusts.
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Reference
3 Zhong J-X, Kang K, Shu X-L. Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis. Asia Pacific J of Clin Nutrition, 2015: 24; 367-78 4
