Malnutrition in emergency general surgery: a survey of National Emergency Laparotomy Audit Leads

IF 2.9 3区医学 Q3 NUTRITION & DIETETICS

Journal of Human Nutrition and Dietetics Pub Date : 2024-03-04 DOI:10.1111/jhn.13293

Daniel L. Ashmore, Timothy Wilson, Vanessa Halliday, Matthew Lee

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引用次数: 0

Abstract

Background

Patients who are malnourished and have emergency general surgery, such as a laparotomy, have worse outcomes than those who are not malnourished. It is paramount to identify these patients and minimise this risk. This study aimed to describe current practices in identifying malnutrition in patients undergoing a laparotomy, specifically focusing on screening, assessment, nutrition pathways and barriers encountered by clinicians.

Methods

Following piloting and validity assessment, anaesthetic and surgical National Emergency Laparotomy Audit (NELA) Leads at hospitals across England and Wales were emailed an invitation to a survey. Responses were gathered using Qualtrics. Descriptive analysis and correlation with laparotomy volume and professional role were performed in SPSSv26. University of Sheffield ethical approval was obtained (UREC 046205). The results from the survey are reported according to the CHERRIES guidelines.

Results

The survey was completed by 166/289 NELA Leads from 117/167 hospitals (57.4% and 70.1% response rates, respectively). Participants reported low rates of nutritional screening (42/166; 25.3%) and assessment (26/166; 15.7%) for malnutrition preoperatively. More than one third of respondents (40.1%) had no awareness of local screening tools; indeed, the Malnutrition Universal Screening Tool (MUST) was used by approximately half of respondents (56.6%). Contrary to guidelines, NELA Leads report albumin levels continue to be used to determine malnutrition risk (73.5%; 122/166). Postoperative nutrition pathways were common (71.7%; 119/166). Reported barriers to nutritional screening and assessment included a lack of time, training and education, organisational support and ownership. Participants indicated nutrition risk is inadequately identified and is an important missing data item from NELA. There was no significant correlation with hospital laparotomy volume in relation to screening or assessment for malnutrition, the use of nutritional support pathways or organisational barriers. There was interprofessional agreement across a number of domains, although some differences did exist.

Conclusions

Wide variation exists in the current practice of identifying malnutrition risk in NELA patients. Barriers include a lack of time, knowledge and ownership. Nutrition pathways that encompass the preoperative phase and incorporation of nutrition data in NELA may support improvements in care.

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急诊普外科手术中的营养不良问题：全国急诊腹腔手术审计负责人调查。

背景：营养不良的急诊普外科手术（如开腹手术）患者的预后比没有营养不良的患者差。识别这些患者并将风险降至最低至关重要。本研究旨在描述目前识别开腹手术患者营养不良的做法，特别关注筛查、评估、营养路径和临床医生遇到的障碍：在进行试点和有效性评估后，通过电子邮件向英格兰和威尔士各医院的麻醉科和外科国家紧急腹腔手术审核（NELA）负责人发出调查邀请。调查问卷使用 Qualtrics 收集。在 SPSSv26 中进行了描述性分析以及与腹腔手术量和专业角色的相关性分析。谢菲尔德大学获得了伦理批准（UREC 046205）。调查结果根据CHERRIES指南进行报告：来自 117/167 家医院的 166/289 名 NELA 负责人完成了调查（回复率分别为 57.4% 和 70.1%）。参与者报告的术前营养筛查率（42/166；25.3%）和营养不良评估率（26/166；15.7%）较低。超过三分之一的受访者（40.1%）不了解当地的筛查工具；事实上，约有一半的受访者（56.6%）使用营养不良通用筛查工具（MUST）。与指南相反，NELA 负责人报告白蛋白水平仍被用于确定营养不良风险（73.5%；122/166）。术后营养路径很常见（71.7%；119/166）。据报告，营养筛查和评估的障碍包括缺乏时间、培训和教育、组织支持和所有权。参与者表示营养风险识别不足，是 NELA 中缺失的重要数据项。在营养不良筛查或评估、营养支持路径的使用或组织障碍方面，与医院开腹手术量无明显关联。虽然存在一些差异，但专业间在多个领域达成了一致：结论：目前在识别 NELA 患者营养不良风险方面存在很大差异。障碍包括缺乏时间、知识和主人翁精神。包括术前阶段在内的营养路径以及将营养数据纳入 NELA 可能有助于改善护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Human Nutrition and Dietetics 医学-营养学

CiteScore

5.30

自引率

15.20%

发文量

133

审稿时长

6-12 weeks

期刊介绍： Journal of Human Nutrition and Dietetics is an international peer-reviewed journal publishing papers in applied nutrition and dietetics. Papers are therefore welcomed on: - Clinical nutrition and the practice of therapeutic dietetics - Clinical and professional guidelines - Public health nutrition and nutritional epidemiology - Dietary surveys and dietary assessment methodology - Health promotion and intervention studies and their effectiveness - Obesity, weight control and body composition - Research on psychological determinants of healthy and unhealthy eating behaviour. Focus can for example be on attitudes, brain correlates of food reward processing, social influences, impulsivity, cognitive control, cognitive processes, dieting, psychological treatments. - Appetite, Food intake and nutritional status - Nutrigenomics and molecular nutrition - The journal does not publish animal research The journal is published in an online-only format. No printed issue of this title will be produced but authors will still be able to order offprints of their own articles.