What influences emergency general surgeons' treatment preferences for patients requiring nutritional support? A discrete choice experiment

Aim: Identifying and managing malnourished emergency general surgery (EGS) patients can be difficult. There are many tools available, a range of barriers to overcome and variety of guidelines at a surgeon's disposal. This study aimed to determine the impact of key variables on surgeon preference to start nutritional support in EGS.

Methods: A discrete choice experiment was used to determine the impact of six variables on surgeons' treatment preferences for commencing nutritional support in EGS. Twenty-five hypothetical scenarios regarding a patient with adhesional small bowel obstruction were disseminated electronically. Binomial logistic regression was used to identify significant associations. Ethical approval was obtained (UREC 050436).

Results: In all, 148 participants responded providing 3700 scenario responses. Completion rate was 52.1% (148/284) with an approximately even split of consultants and non-consultants (50.7% vs. 49.3%) and intestinal failure (IF) experience (46.6% experienced vs. 53.4% not experienced). Consultants favoured starting nutritional support (77.7%; 1443/1875) more often than non-consultants (71.8%; 1310/1825). Forming an anastomosis, hypoalbuminaemia, underweight (body mass index <18.5 kg/m²), unintentional weight loss (>10%), ≥5 days without oral intake until now and ≥5 days likely to be without oral intake from now were statistically more likely to be associated with treatment preference, but obesity (body mass index >30 kg/m²) was not. Overall, experience of IF (OR 1.093, 95% CI 0.732–1.631; P = 0.663) and seniority of surgeon (OR 0.711, 95% CI 0.473–1.068; P = 0.100) significantly influenced the results.

Conclusions: There are many variables that impact the decision to start nutritional support in EGS, but seniority of the surgeon and IF experience do not.