Evaluating nutritional screening and support in older patients undergoing emergency colorectal surgery: a clinical audit

Background: Malnutrition is a common, yet modifiable risk factor in older surgical patients, and is associated with higher postoperative morbidity and mortality. National guidance (NICE, 2017) recommends that nutritional risk be assessed using validated tools such as the Malnutrition Universal Screening Tool (MUST) with clear care pathways for dietetic support and oral nutritional supplementation (ONS) where needed. Aim: To evaluate, through a clinical audit, how effectively MUST scores are recorded and acted upon in older patients undergoing emergency colorectal surgery. Methods: A retrospective clinical audit of patients aged ≥65 who underwent emergency laparotomy at a UK NHS teaching hospital (Jan 2021—Dec 2022). Electronic records were reviewed for MUST scores, dietetic referrals and ONS prescriptions. Results: Of 300 patients, 99% had a recorded MUST score. Among 114 patients identified as high-risk, 35% did not receive a dietetic review, and 24% received no nutritional supplementation. Conclusion: Although screening compliance was high, many high-risk patients did not receive appropriate follow-up. These findings highlight a breakdown between screening and intervention, suggesting the need for improved protocol adherence and clearer accountability in perioperative nutritional care. Improving adherence to nutritional care protocols may help reduce postoperative complications and support better recovery outcomes in older surgical patients.