Managing micronutrients in metabolic and bariatric surgery: A mixed methods study of Australian dietitians' practice...

Dietitians play key roles in the care of patients undergoing metabolic and bariatric surgery, including micronutrient management. This study aimed to explore Australian dietitians' practices and perspectives on managing micronutrients in bariatric surgery.

A mixed methods study of sequential explanatory design was conducted including a cross-sectional survey and semi-structured interviews. Eligible participants were Accredited Practising Dietitians caring for patients undergoing bariatric surgery. A 20-item study-specific practice survey was distributed electronically, and results were analysed descriptively. Interviewees were recruited via the survey and professional networks. Interviews were conducted, audio-recorded, transcribed and analysed using inductive thematic analysis. Findings were integrated following separate analysis.

Forty-five eligible dietitians responded to the survey and eight dietitians were interviewed. Practice findings showed pathology tests were most frequently ordered at the 6- and 12-month postoperative timepoints, and oral multivitamins were recommended postoperatively. Divergence across dietitians was seen in repletion practice and the clinical resources used, particularly in private versus public services. Interview findings were mostly consistent with survey results, and two themes identified were individualising supplementation and anticipating future needs.

Dietitians' practice on monitoring micronutrient status and postoperative supplementation was broadly consistent. Inconsistent practice in repletion of deficiencies was related to differing models of care. Despite perceiving that patients have a high prevalence of micronutrient deficiency preoperatively, dietitians did not prioritise managing micronutrients until after surgery, largely for practical reasons. More research is needed to improve the evidence-based practice in this area.