Parental nutrition in emergency surgery: A multicentre cross‐sectional study. Issue 1 (14th May 2021)

• Record Type: Journal Article
• Authors: Ashmore, Daniel; Lee, Matthew
• Other Names: Ball William investigator.; Blanshard Lucy investigator.; Craig Andrew investigator.; Schinkwin Michael investigator.; Nottingham Chloe investigator.; Davies Michael M investigator.; Ahmad Shahrukh investigator.; Kourdouli Amar investigator.; Duff Sarah investigator.; Fahmy Sameh investigator.; Fowler George E investigator.; Manu Nichola investigator.; Povey Meical investigator.; Rozwadowski Sophie investigator.; Smart Neil investigator.; Vimalachandran Dale investigator.; Blencowe Natalie investigator.; Miller Andrew investigator.; Kourdouli Amar investigator.
• Is Part Of: Journal of human nutrition and dietetics. Volume 35:Issue 1(2022)
• Page Start: 5
• Page End: 13
• Publication Date: 2021-05-14
• Subjects: decision‐making -- delivery of nutrition -- emergency general surgery -- nutritional assessment -- parenteral nutrition; Dietetics -- Periodicals; Nutrition -- Periodicals; 613.205
• DOI: 10.1111/jhn.12902
• Languages: English
• ISSNs: 0952-3871

Abstract

Abstract: Background: Emergency general surgical patients are inherently at high risk of malnutrition. Early decision‐making with implementation is fundamental to patient recovery. For many patients, parenteral nutrition (PN) is the only feeding option available. The present study assessed the timing and outcomes of this decision‐making process. Methods: A sample of at least 10 consecutive adult patients admitted as a general surgical emergency to eight UK hospitals over 1 year who had received PN was identified. Patient demographics, basic descriptors and nutritional data were captured. Process measures regarding dates decisions were made or activities completed were extracted from records, as were outcome measures including PN complications. Six time frames examining the process of PN delivery were analysed. Associations between categorical and binary variables were investigated with a chi‐squared test with significance determined as p < 0.05. Results: In total, 125 patients were included. Intestinal obstruction was the most common diagnosis with 59% of all patients deemed high risk on nutritional assessment at admission. Median time to decision for PN was 5 days following admission ( n = 122, interquartile range = 7). Patients received PN for a mean of 11 days. Eighty‐five percent of patients developed a complication, with a phosphate abnormality being the most commonly reported (54%). Only altered blood glucose levels appeared to correlate with a delay in starting PN ( p < 0.01). Conclusions: The present study shows there are delays in the decision to use PN in the acutely ill surgical patient. Once initiated, the pathway is relatively short. There are high rates of electrolyte abnormalities in this population. Abstract : Emergency general surgical (EGS) patients are inherently high risk of malnutrition, which has been linked to poorer outcomes. This multicentre study assessed the timing and outcomes of this decision‐making process in relation to EGS patients who had received parenteral nutrition (PN). In essence, there are delays in the decision to use PN in the acutely ill surgical patient but, once initiated, the pathway is relatively short.