SU12.1 | Surgical Malnutrition — Summary & Reflection

KEY TAKEAWAYS

Malnutrition is the commonest modifiable risk factor in surgery — present in a third to a half of surgical inpatients and usually worsening during admission. It means a deficiency, excess or imbalance of nutrients that harms body composition, function and outcome, and in surgery usually means undernutrition. Its types are marasmus (balanced energy/protein deficit, severe wasting, preserved albumin), kwashiorkor (protein deficit, hypoalbuminaemia and oedema), the common mixed marasmic-kwashiorkor, plus sarcopenia, micronutrient deficiency and obesity with hidden deficiency. Its causes group into reduced intake, impaired digestion/absorption, increased losses, and the increased catabolic requirement that makes the surgical patient special. Its consequences are system-wide — impaired wound healing and anastomotic leak, immune suppression and sepsis, respiratory-muscle wasting with failure to wean, gut atrophy and bacterial translocation, organ and psychological dysfunction — translating into greater morbidity, mortality, length of stay and cost. Assessment rests on history and examination (especially documented weight loss >10% over 3–6 months), anthropometry (BMI, MUAC, serial weight), the outcome-predictive SGA (A–C), screening tools (MUST, NRS-2002) and cautiously interpreted biochemistry — remembering that albumin and prealbumin are negative acute-phase reactants and that a normal albumin never excludes malnutrition. Make malnutrition visible and you can treat it; this is the foundation for the nutritional and fluid support that follows.

REFLECT

Think back to a surgical patient you have seen who healed badly, became septic, or could not be weaned from the ventilator. Looking back, were there signs of malnutrition that were present but unmeasured — visible wasting, a history of weight loss, a long period nil-by-mouth? Was the patient ever actually weighed, and was a structured tool such as SGA or MUST ever applied, or was a 'normal' albumin taken as false reassurance? Map their course onto the four causal groups and the system-by-system consequences. How would routinely screening every surgical admission, and treating a low albumin as a marker of illness rather than starvation, change the way you anticipate and prevent complications in your next patient?