Parental nutrition in emergency surgery: a multicentre cross-sectional study.

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. This study assesses 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 one year whom 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 chi-squared test with significance determined if p <0.05. RESULTS A total of 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 five days following admission (n = 122, IQR 7). Patients received PN for a mean of 11 days. Eighty-five percent of patients developed a complication; a phosphate abnormality was the most commonly reported (54%). Only altered blood glucose levels appeared to correlate with a delay in starting PN (p<0.01). CONCLUSION This 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.