Does preoperative total parenteral nutrition in patients with ulcerative colitis produce better outcomes?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Malnutrition is a frequent problem in patients with ulcerative colitis (UC) leading to increased postoperative complication rates. Preoperative total parenteral nutrition (TPN) has been shown to reduce complications in some subgroups of patients, but has not been studied in UC. We investigated the impact of preoperative TPN on postoperative complication rates in patients undergoing surgery for UC.
This paper is a review of 235 patients who underwent surgery for UC; 56 received preoperative TPN and 179 did not. Postoperative complication rates were compared.
Both had similar rates of anastomotic leak (5.4 vs. 2.8 %, p = 0.356), infection (12.5 vs. 20.1 %, p = 0.199), ileus/bowel obstruction (21.4 vs. 15.6 %, p = 0.315), cardiac complications (3.6 vs. 0 %, p = 0.056), wound dehiscence (3.6 vs. 1.7 %, p = 0.595), reoperation (10.7 vs. 3.9 %, p = 0.086), and death (1.8 vs. 0 %, p = 0.238). The TPN group was more malnourished (albumin 2.49 vs. 3.45, p < 0.001), more often on steroids (83.9 vs. 57.5 %, p < 0.001), had more emergent surgery (10.7 vs. 3.4 %, p = 0.029), more severe colitis (89.3 vs. 65.9 %, p = 0.001), and lower Surgical Apgar Score (6.15 vs. 6.57, p = 0.033). After controlling for these with logistic regression, the TPN group still had higher complication rates (OR 2.32, p = 0.04). When line infections were excluded, TPN did not significantly affect outcomes (OR 1.5, p = 0.311)
There were no differences in postoperative complications when line infections were excluded. Our data does not support routine preoperative TPN in patients with UC. However, it may lead to equal surgical outcomes in the sickest and most malnourished patients at the cost of line-related morbidity.
- Does preoperative total parenteral nutrition in patients with ulcerative colitis produce better outcomes?
International Journal of Colorectal Disease
Volume 27, Issue 11 , pp 1479-1483
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Inflammatory bowel disease
- Ulcerative colitis
- Colorectal surgery
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- 2. Department of Gastroenterology, Crohn’s and Colitis Center at Massachusetts General Hospital, Boston, MA, USA
- 3. Department of Surgery, Crohn’s and Colitis Center at Massachusetts General Hospital, Boston, MA, USA
- 4. Department of Surgery, Massachusetts General Hospital Crohn’s and Colitis Center, 15 Parkman Street, ACC 460, Boston, MA, 02114, USA