Aim
The purpose of this mixed methods study in patients undergoing skull base surgery was to improve knowledge of nutrition and swallowing outcomes and increase understanding of the patient experience of current perioperative nutrition care.
Methods
A cohort study of patients who underwent complicated skull base surgery over a five-year period (2018-2022) at a tertiary hospital in Brisbane, Australia, were identified for a retrospective chart audit. Nutrition and swallowing outcomes in the retrospective cohort were evaluated at baseline (on admission), during admission and up to three months post-operatively, and included nutritional status, weight loss, swallowing function, diet prescription, tube feeding, allied health occasions of service and length of stay.
In addition eighteen adults who underwent skull base surgery (January 2018 – July 2024) were recruited for interviews via convenience sampling from theatre lists and ENT outpatient follow-up appointments. Semi-structured interviews were used and conducted by a dietitian not involved in participants’ care and analysed using reflexive thematic analysis.
Results
Forty patients were included in the retrospective cohort study (mean age 57 years and 68% male). Percentage weight loss was 3-4% at discharge and 8-9% at three months post-surgery. Texture modification of diet was common in the post-operative period, but only 1 patient was diagnosed with dysphagia and required tube feeding at three months.
Eighteen patients were interviewed (median age 61 years and 72% male) and represented rural, regional and metropolitan locations. Five key themes emerged: (1) Nutrition is not a priority—patients focused on survival, often overlooking dietary needs; (2) Limited awareness of allied health—uncertainty about the roles of dietitians and speech pathologists affected engagement; (3) Feeling disconnected post-discharge—patients reported and lack of follow-up; (4) Complexity of informed consent—patients struggled to absorb information pre-surgery; and (5) Social withdrawal—changes in function vulnerability and appearance led to social isolation.
Conclusion and clinical implications
The findings underscore the need for a holistic, multi-disciplinary patient-centred approach to skull base surgery care. Nutrition and allied health support were often undervalued due to limited awareness and engagement with staff. These insights support the development of multidisciplinary strategies that address patients’ lived experience and healthcare needs.