Assessment for the risk of malnutrition and nutritional support in older emergency laparotomy patients: a clinical audit
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All Authors
Windle, Angela
Burke, Dermot
Ispoglou, Theocharis
LTHT Author
Burke, Dermot
LTHT Department
Abdominal Medicine & Surgery
General Surgery
General Surgery
Non Medic
Publication Date
2025
Item Type
Conference Abstract
Language
Subject
Subject Headings
Abstract
BACKGROUND
Malnutrition is a complex diagnosis in older surgical patients, often coexisting with multiple comorbidities alongside a presenting surgical complaint. Addressing nutritional deficiencies may improve surgical outcomes and reduce hospital stay duration and mortality risk (Ashmore et al., 2023). At LTHT, patients undergoing emergency abdominal surgery should be assessed for malnutrition risk upon admission to the surgical department using the Malnutrition Universal Screening Tool (MUST) (NICE, 2017). A high-risk MUST score recorded by registered professionals should trigger the prescribing of nutritional support and/or dietetic referral.
AIM
This clinical audit had two main aims:
1. To determine whether older patients undergoing emergency abdominal surgery were screened for the potential risk of malnutrition using MUST.
2. To assess whether high-risk patients received appropriate nutritional support to address deficiencies in line with NICE (2017) guidelines.
METHODS
Patients aged 65 years or older who underwent emergency laparotomy between January 1, 2021, and December 31, 2022, were included. Electronic records were reviewed to confirm MUST score documentation at admission. For high-risk patients, the prescription of nutritional supplementation and/or dietetic referrals were assessed.
RESULTS
Among 300 patients, 98% had a documented MUST score. Of these, 114 (38%) were identified as high-risk; however, 35% did not receive a dietetic review, and 24% were not prescribed any nutritional supplementation.
CONCLUSIONS
High-risk MUST scores in older patients are readily available to surgical teams within the electronic patient record but do not consistently lead to interventions addressing nutritional deficiencies via nutritional supplement prescribing or expert dietetic review. While MUST scoring is well-embedded in clinical practice at LTHT, the focus should now shift towards improving the implementation of findings to ensure high-risk patients receive appropriate nutritional interventions.