Prevalence of malnutrition after major surgery

Since Butterworth first published his paper 'The skeleton in the hospital closet' in 1974, it has been known that malnutrition is a significant factor in determining the outcome of illness for many patients (Butterworth, 1974). However, the problem still exists 20 years after this publication appeared. Those who undergo major surgery are at greater risk of malnutrition than most because of the stress and the concomitant increase in metabolic rate caused by the surgery. This paper reports the prevalence of malnutrition in patients who had undergone major surgery within 6 weeks of being surveyed and who were living in the community under their general practitioner's care. One hundred and twenty-three patients (74 men and 49 women) took part in the survey. A total of 13 (10.6%) patients were malnourished, 10 (8.1%) mildly and 3 (2.4%) severely malnourished. The problem was more prevalent in those who had undergone genito-urinary and gastrointestinal surgery, of whom 33% (2 out of 6) and 20.6% (7 out of 34), respectively, were malnourished. Surprisingly, there was a significantly higher proportion of women in the malnourished than in the non-malnourished group (P=0.047), Furthermore, malnourished patients were significantly younger than non-malnourished patients (P=0.034). In surgical patients, pre-operative nutritional assessment, a course of feeding prior to surgery in malnourished patients, and early post-operative feeding in all patients, could help to reduce the incidence of malnutrition in post-operative patients, and consequently reduce the cost to the National Health Service (NHS).