Introduction: Poor nutritional status of surgical patients is associated with delayed recovery, increased length of stay (LOS), and higher rates of post-surgical complications. Enhanced Recovery After Surgery (ERAS) protocols offer evidence-based guidelines for optimal perioperative nutrition with the goal of minimizing duration of fasting and inadequate diet orders. Diet ordering practices occurring within Island Health surgical wards are unclear.

Objective: To describe the duration patients are ordered nutritionally inadequate diets and the nutrition provided during admission within surgical wards at Island Health.

Methods: Food service reports from Island Health’s CBORD® database were retrospectively reviewed for a simple random sample of 126 patients from Victoria General Hospital and Nanaimo Regional General Hospital. Diets ordered and calories (kcal) and protein (grams) provided for each day of admission were analyzed using REDCap™ and SPSS®. Diets of inadequacy were analyzed separately and identified in subjects with diet orders of clear fluid (CF), full fluids (FF), and/or Nil Per Os (NPO) for ≥ 3 days cumulatively. 
 
Results: Subject median age was 69 years (range 19-99) with a median LOS of 4.8 days (range 3.0-20.6). Diets provided an average of 1448±422 kcal and 65.8±22.4 grams of protein daily. Diet orders of CF, FF, and NPO were ordered for a mean of 1.4, 1.8 and 0.9 days respectively. Diets of inadequacy were found for 19.8% (n=25) of subjects and provided a daily average of 1026±363 kcal and 42.4±18.4 grams of protein. 

Conclusions: Some patients within Island Health surgical wards are not receiving adequate nutrition to support healing and recovery. The inability to distinguish surgical from non-surgical patients or to assess individual nutritional needs using CBORD data limited interpretation of results.

Significance to the field of dietetics: These findings highlight the importance of dietitians to advocate for consistent implementation of evidence-based feeding practices to ensure adequate nutrition for healing and recovery.

Nutrition in surgical wards: A retrospective study describing the diets and nutrition provided within Island Health