Nutritional management of patients undergoing major upper gastrointestinal surgery: A survey of current practice in Australia

Abstract

Abstract Aim: The aim of the present study was to survey current nutrition practice in Australian hospitals for the management of patients undergoing major upper gastrointestinal surgery, and to compare this with best practice, as it currently appears in the literature. Methods: A literature review was conducted to obtain current recommendations for the nutritional management of patients undergoing major upper gastrointestinal surgery. A survey was constructed to investigate whether these recommendations are being followed. Dietitians from tertiary‐referral public and private hospitals across Australia were contacted by telephone and invited to respond to the survey questions. Results: Forty‐two hospitals were contacted and 34 dietitians responded to the survey questions. Sixty‐three percent of dietitians reported minimal or no preoperative assessment of surgical patients, but 50% stated that they recommended immunonutrition when they did have preoperative contact, the majority following established dosage recommendations. Postoperative enteral nutrition support is not standard practice, being used routinely in only 30% of hospitals surveyed. Nutrition is usually recommenced on postoperative day 2 or 3. Post‐discharge follow up was provided by 35% of dietitians surveyed. Conclusion: Current recommendations in all aspects of nutrition are not being followed and there is great scope for improvement in managing patients undergoing major gastrointestinal surgery. Best practice guidelines and a shift in service provision to include better outpatient support for such a patient group is required.