International Journal of Colorectal Disease

, Volume 27, Issue 11, pp 1479–1483

Does preoperative total parenteral nutrition in patients with ulcerative colitis produce better outcomes?

Authors

  • Harry Salinas
    • Department of SurgeryMassachusetts General Hospital
  • Abdulmentin Dursun
    • Department of SurgeryMassachusetts General Hospital
  • Ioannis Konstantinidis
    • Department of SurgeryMassachusetts General Hospital
  • Deanna Nguyen
    • Department of GastroenterologyCrohn’s and Colitis Center at Massachusetts General Hospital
  • Paul Shellito
    • Department of SurgeryCrohn’s and Colitis Center at Massachusetts General Hospital
  • Richard Hodin
    • Department of SurgeryCrohn’s and Colitis Center at Massachusetts General Hospital
    • Department of SurgeryCrohn’s and Colitis Center at Massachusetts General Hospital
    • Department of SurgeryMassachusetts General Hospital Crohn’s and Colitis Center
Original Article

DOI: 10.1007/s00384-012-1535-2

Cite this article as:
Salinas, H., Dursun, A., Konstantinidis, I. et al. Int J Colorectal Dis (2012) 27: 1479. doi:10.1007/s00384-012-1535-2

Abstract

Purpose

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.

Methods

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.

Results

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)

Conclusion

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.

Keywords

Inflammatory bowel diseaseUlcerative colitisColorectal surgeryNutrition

Copyright information

© Springer-Verlag 2012