# The influence of surgeon seniority and intestinal failure experience on identifying malnourished patients in emergency general surgery: a national survey

## TL;DR

This study explores how surgeon experience and intestinal failure knowledge affect the ability to identify malnutrition in emergency surgery patients.

## Contribution

The study characterizes surgeon awareness and training gaps in identifying malnutrition, linking confidence to intestinal failure experience.

## Key findings

- Only 37.2% of surveyed surgeons felt confident identifying malnutrition in emergency surgery patients.
- Surgeons with intestinal failure experience were significantly more confident in identifying malnutrition.
- Most surgeons reported poor training in malnutrition identification and supported formal training initiatives.

## Abstract

Variation exists in how consultant surgeons identify malnutrition in emergency general surgery (EGS) patients. These relate to differences in surgeon knowledge, understanding, ownership and hospital setting. Little is known regarding how these relate to nonconsultant surgeons, or those with experience of intestinal failure (IF).

This study aimed to characterise the awareness, practice and training of general surgeons in the identification of malnutrition in the emergency setting.

The survey focused on three domains: perceptions, current practices and nutrition training. Following piloting, EGS surgeons were invited to complete an online survey. Responses were gathered using Qualtrics. Descriptive analysis and associations with surgeon seniority and IF were performed in SPSSv26. Ethical approval was obtained (UREC 050436). Results are reported with reference to the CHERRIES guidelines.

The completion rate was 52.1% (148/284), of whom 49.7% were nonconsultant surgeons and 46.6% had experience of IF. Surgeons from all UK regions completed the survey. There was strong agreement across participants that malnutrition can affect surgical outcomes and identifying it was an important skill for surgeons. However, only 37.2% (55/148) were confident in doing so. Surgeons with IF experience were significantly more confident than those without (49.3% vs 26.6%). Training was reportedly poor, and local teaching or a short course aimed at surgeons in training was considered most helpful in the future.

Identifying malnutrition in EGS is recognised as an important skill most surgeons feel they are lacking. Support for formal training in this area was high.