Barriers to nutrition following neurosurgery: A descriptive cohort study

Neurological trauma results in a state of hypermetabolism. Existing literature has explored barriers to adequate nutrition following traumatic brain injury. Despite clinical similarities, it remains unclear whether similar nutritional barriers are faced following both planned and emergency neurosurgical procedures. This study aimed to describe nutritional management, the prevalence of barriers to nutrition, and their association with selected patient outcomes among longer-stay patients undergoing neurosurgical procedures.

Medical records were reviewed for hospitalised neurosurgery patients admitted >13 days, including a postoperative intensive care unit (ICU) stay ≥24 h, between January 2021 and June 2023. Demographic data, nutritional status (Subjective Global Assessment [SGA]), and documented barriers to adequate nutrition were collected. Multivariable linear regression was used to explore associations between variables.

Of the 166 eligible patients, 101 (60.8%) were seen by a dietitian and 86 had a SGA completed of which 21 developed hospital-acquired malnutrition. Barriers to nutrition were identified among 154 (92.8%) patients, with a median of 5.0 (3.0, 8.0) per patient. The most prevalent included procedural fasting (n = 100) and feeding tube problems (n = 90). Experiencing 5 barriers was associated with an increased likelihood of ICU re-admission (p = 0.02) and hospital-acquired malnutrition (p = 0.04). Barriers to nutrition during ICU admission were associated with longer subsequent length of stay on the ward (p = 0.006).

Longer-stay neurosurgical patients are a nutritionally vulnerable cohort with a high prevalence of barriers to nutrition. Further interventional research is needed to determine whether addressing these barriers leads to improved clinical outcomes.