Does preoperative total parenteral nutrition in patients with ulcerative colitis produce better outcomes?
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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.
- Dempsey, DT, Mullen, JL, Buzby, GP (1988) The link between nutritional status and clinical outcome: can nutritional intervention modify it?. Am J Clin Nutr 47: pp. 352-356
- Heyland, DK, Montalvo, M, MacDonald, S (2001) Total parenteral nutrition in the surgical patient: a meta-analysis. Can J Surg 44: pp. 102-111
- Perioperative total parenteral nutrition in surgical patients. N Engl J Med 325: pp. 525-532 CrossRef
- Fan, ST, Lo, CM, Lai, EC (1994) Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. N Engl J Med 331: pp. 1547-1552 CrossRef
- Charlson, ME, Pompei, P, Ales, KL (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40: pp. 373-383 CrossRef
- Gawande, AA, Kwaan, MR, Regenbogen, SE (2007) An Apgar score for surgery. J Am Coll Surg 204: pp. 201-208 CrossRef
- Weimann, A, Braga, M, Harsanyi, L (2006) ESPEN Guidelines on Enteral Nutrition: surgery including organ transplantation. Clin Nutr 25: pp. 224-244 CrossRef
- Rombeau, JL, Barot, LR, Williamson, CE (1982) Preoperative total parenteral nutrition and surgical outcome in patients with inflammatory bowel disease. Am J Surg 143: pp. 139-143 CrossRef
- 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
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- 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