Recognising nutritional risk status of older adults undergoing elective surgery in a tertiary hospital in Wales.

Introduction 

Malnutrition in older adults undergoing surgery is associated with increased adverse outcomes, hospitalisation and length of stay.  Preoperative nutrition risk screening is recommended for all patients undergoing intermediate or major surgery. In 2024, a Perioperative care of Older People undergoing Surgery (POPS) service was established in a tertiary centre to deliver comprehensive preoperative assessment and optimisation. In the absence of dietetic funding, a nutrition pathway was implemented to identify patients at risk of malnutrition using the Malnutrition Universal Screening Tool (MUST).  

We conducted a service evaluation to describe the incidence of malnutrition risk in patients attending a preoperative POPS clinic.  

Method 

Data were collated prospectively for patients reviewed by the POPS service between January - December 2025. Patient demographics, clinical frailty scale (CFS) score, surgical severity, MUST score and nutritional interventions were noted.  

Results   

A total of 309 patients were included in the analysis (median age 79 years, median CFS 6, 51% female, 49% male). 155 were referred for ‘urgent suspected cancer’. 121 patients (39%) were referred for intermediate or major risk surgery, of whom 28% (n=34) were identified to be at risk of malnutrition – 8% (n=10) were at moderate risk and 20% (n=24) high risk. All patients at risk accepted food fortification advice. Half of the high-risk individuals were not known to dietetic services prior to POPS screening and would otherwise not have been offered oral nutritional supplements. 

Conclusions  

The incidence of malnutrition risk in the POPS cohort undergoing intermediate or major surgery is 28%. Nutrition risk screening has been feasibly established without additional dietetic funding to ensure identification and early interventions, reducing perioperative risk.