A survey of preoperative surgical nutrition practices, opinions, and barriers across Canada

Rationale: Malnutrition is prevalent and associated with adverse outcomes. Despite being modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a survey to understand healthcare professionals’ (HCP) opinions and barriers regarding screening and treatment of malnutrition. Methods: HCPs working with adult surgical patients in Canada were invited to complete an online survey with open- and closed-ended questions. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data using content analysis. Results: Of 225 HCPs (n=111 dietitians, n=72 physicians, n=42 allied health), 96%-100% believed that perioperative malnutrition is a modifiable risk factor associated with worse outcomes and is a treatment priority. Only 63% (n=141/225; dietitians:88% vs physicians:40%) of respondents reported screening for malnutrition, and 42% (48/113) referred positively screened patients to a dietitian. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n=121/212), time (40%, n=84/212) and support from others (38%, n=80/212). Qualitative findings suggest a perceived difficulty in meeting demands of screening as a preventative care given the mandate of tertiary care organizations. HCPs suggested the referral process begin in the surgeons’ office and involve a collaboration between acute and primary care settings. Conclusion: There is a gap between perception and practice among surgical HCPs pertaining to perioperative malnutrition. Although HCPs believe treatment for malnutrition is a priority, the opportunity to screen for nutrition risk was a great barrier. To address this gap, HCPs suggest the preoperative nutrition care pathway be re-imagined with a link to primary care services. Disclosure of Interest: None declared