Postoperative complications in colorectal surgery in relation to preoperative clinical and nutritional state and postoperative nutritional treatment

  • S. Fasth
  • L. Hultén
  • O. Magnusson
  • S. Nordgren
  • I. Warnold
Original Articles


The impact of the pre-operative nutritional and clinical state on post-operative morbidity and mortality is not fully known and the effect of total parenteral nutrition (TPN) on the postoperative complication rate has not been established. We have investigated the effects of postoperative TPN on the complication rate in 92 patients after major colorectal surgery for carcinoma of the large bowel or inflammatory bowel disease in a controlled, randomised study. The complication rate was analysed against seven commonly used nutritional (biochemical and anthropometric) variables and against the diagnosis, clinical inflammatory activity and presence of pre-operative septic complication. Patients were randomly allocated to postoperative TPN or conventional fluid and electrolyte support. The results show no correlation between the complication rate and the nutritional and clinical state of the patients as assessed pre-operatively. The complication rate was not significantly reduced by postoperative TPN. This study indicates that biochemical and anthropometric nutritional variables do not identify patients at risk to develop postoperative complications. The presence of pre-operative complications showed a marginal correlation with postoperative morbidity, in agreement with previous experience. The result of this study obviates the use of TPN in routine postoperative care.


Inflammatory Bowel Disease Postoperative Complication Complication Rate Colorectal Surgery Postoperative Morbidity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Studley HO (1936) Percentage of weight loss. A Basic indicator of surgical risk in patients with chronic peptic ulcer. JAMA 106:458–460Google Scholar
  2. 2.
    Mullen JL, Gertner MH, Buzby GP, Goodhart GL, Rosato EF (1979) Implications of malnutrition in the surgical patient. Arch Surg 114:121–125Google Scholar
  3. 3.
    Warnold I, Lundholm K (1984) Clinical significance of preoperative nutritional status in 215 non-cancer patients. Ann Surg 199:299–305Google Scholar
  4. 4.
    Irvin TT, Goligher JC (1973) Aetiology of disruption of intestinal anastomoses. Br J Surg 60:461–464Google Scholar
  5. 5.
    Irvin TT, Hunt TK (1974) Effect of malnutrition on colonic healing. Ann Surg 180:765–772Google Scholar
  6. 6.
    Buzby G, Mullen J, Matthews D, Hobbs C (1980) Prognostic nutritional index in gastrointestinal surgery. Am J Surg 139: 160–167Google Scholar
  7. 7.
    Klidjian AM, Foster KI, Kammerling RM, Cooper A, Karran SJ (1980) Relation of anthropometric and dynamometric variables to serious postoperative complications. Br Med J 281:899–901Google Scholar
  8. 8.
    Ryan JA Jr, Taft DA (1981) Preoperative nutritional assessment does not predict morbidity and mortality in abdominal operations. Surg Forum 31:96–98Google Scholar
  9. 9.
    Detsky A, Baker JP, Mendelson RA, Wolman SL, Wesson DE, Jeejeebhoy KN (1984) Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. JPEN 8:153–159Google Scholar
  10. 10.
    Koretz R (1984) What supports nutritional support? Dig Dis Sci 29:577–588Google Scholar
  11. 11.
    Talstad J, Gjone E (1976) The disease activity of ulcerative colitis and Crohn's disease. Scand J Gastroenterol 11:403–408Google Scholar
  12. 12.
    Bruce Å, Andersson M, Arvidsson B, Isaksson B (1980) Body composition. Prediction of normal body potassium, body water and body fat in adults on the basis of body height, body weight and age. Scand J Clin Lab Invest 40:461–473Google Scholar
  13. 13.
    Symreng T (1982) Arm anthropometry in a large reference population and in surgical patien ts. Clin Nutr 1:211–219Google Scholar
  14. 14.
    Siegel S (1956) Nonparametric statistics. Mc Graw-Hill Kogakusha, TokyoGoogle Scholar
  15. 15.
    Higgens CS, Keighley MRB, Allan RN (1981) Impact of preoperative weight loss on postoperative morbidity. J R Soc Med 74:571–573Google Scholar
  16. 16.
    Freeman M, Frankmann C, Bech J, Valdiviero M (1982) Prognostic nutritional factors in lung cancer patients. JPEN 6:122–127Google Scholar
  17. 17.
    Forse AR, Shizgal HM (1980) The assessment of malnutrition. Surgery 88:17–24Google Scholar
  18. 18.
    Seltzer M, Fletcher S, Slocum B, Engler P (1981) Instant nutritional assessment in the intensive care unit. JPEN 5:70–72Google Scholar
  19. 19.
    Harvey K, Moldarver L, Bistrian B, Blackburn G (1981) Biological measures for the formulation of a hospital prognostic index. Am J Clin Nutr 34:2013–2022Google Scholar
  20. 20.
    Golden M (1982) Transport proteins as indices of protein status. Am J Clin Nutr 35:1159–1165Google Scholar
  21. 21.
    Dominioni L, Dionigi R, Jemos V (1981) The acute phase response of plasma proteins in surgical patients. In: Wesdorp RIC, Soeters PB (eds) Clinical nutrition. Butler and Tanner, Frome LondonGoogle Scholar
  22. 22.
    Steinfeld J L, Davidson J D, Gordon Jr R S, Greene F E (1960) The mechanism of hypoproteinemia in patients with regional enteritis and ulcerative colitis. Am J Med 29: 405–415Google Scholar
  23. 23.
    Moore FD, Olesen KH, McMurrey JD, Parker UH, Ball MR, Magnus Boyden C (1963) The Body Cell Mass and its supporting environment. WB Saunders, Philadelphia LondonGoogle Scholar
  24. 24.
    Fasth S, Hellberg R, Hultén L, Magnusson O (1980) Early complications after surgical treatment for Crohn's disease with particular reference to factors affecting their development. Acta Chir Scand 146:519–526Google Scholar
  25. 25.
    Christiansen L, Fischerman K, Lykkegaard Nielsen M (1973) Early complications after surgical treatment of Crohn's disease. Scand J Gastroenterol 8:651–656Google Scholar
  26. 26.
    Higgens C, Allan KN, Keighley MRB, Arabi Y, Alexander-Williams J (1980) Sepsis following operation for inflammatory bowel disease. Dis Colon Rectum 23:102–105Google Scholar
  27. 27.
    Holter AR, Fischer JE (1977) The effects of perioperative hyperalimentation on complications in patients with carcinoma and weight loss. J Surg Res 23:31–34Google Scholar
  28. 28.
    Moghissi K, Hornshaw J, Teasdale PR, Dawes EA (1977) Parenteral nutrition in carcinoma of the oesophagus treated by surgery: nitrogen balance and clinical studies. Br J Surg 64:125–128Google Scholar
  29. 29.
    Collins FP, Oxby CB, Hill GL (1978) Intravenous aminoacids and intravenous hyperalimentation as protein-sparing therapy after major surgery. Lancet 1:788–791Google Scholar
  30. 30.
    Preshaw RM, Attisha RP, Hollingsworth WJ, Todd JD (1979) Randomized sequential trial of parenteral nutrition in healing of colonic anastomoses in man. Can J Surg 22:437–439Google Scholar
  31. 31.
    Heatley RV, Williams RH, Lewis MH (1979) Pre-operative intravenous feeding. A controlled trial. Postgrad Med J 55: 541–545Google Scholar
  32. 32.
    Thompson BR, Julian TB, Stremple JF (1981) Perioperative total parenteral nutrition in patients with gastrointestinal cancer. J Surg Res 30:497–500Google Scholar
  33. 33.
    Simms JM, Oliver E, Smith JAR (1980) A Study of total parenteral nutrition (TPN) in major gastric and esophageal resection for neoplasia. JPEN 4:422Google Scholar
  34. 34.
    Lim STK, Choa RG, Lam KH, Wong J, Ong B (1981) Total parenteral nutrition versus gastrostomy in the preoperative preparation of patients with carcinoma of the oesophagus. Br J Surg 68:69–72Google Scholar
  35. 35.
    Schildt B, Groth O, Larsson J, Sjödahl R, Symreng T, Wetterfors J (1981) Failure of preoperative TPN to improve nutritional status in gastric carcinoma. JPEN 5:360Google Scholar
  36. 36.
    Müller JM, Dienst C, Brenner U, Pichlmaier H (1982) Preoperative parenteral feeding in patients with gastrointestinal carcinoma. Lancet 1:68–71Google Scholar
  37. 37.
    Moghissi M, Teasdale P, Dench M (1982) Comparison between preoperative enteral (naso-gastric tube) and parenteral feeding in patients with cancer of the oesophagus undergoing surgery. JPEN 6:335Google Scholar
  38. 38.
    Jensen St, Ginnerup P (1982) Total parenteral ernaering perioperativt til patienter med adenocarcinoma recti. Ugeskr Laeger 144:460–463Google Scholar
  39. 39.
    Dionigi P, Interdonato FP, Prati U, Jemos V, Dionigi R (1985) Perioperative TPN and postoperative septic complications in Patients with gastric cancer. ESPEN, 7th Congress, September 1985, Munich, p 114Google Scholar
  40. 40.
    Müller JM, Keller HW, Brenner U, Walter M, Holzmüller W (1986) Indications and effects of pre-operative parenteral nutrition. World J Surg 10:53–63Google Scholar

Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • S. Fasth
    • 1
  • L. Hultén
    • 1
  • O. Magnusson
    • 1
  • S. Nordgren
    • 1
  • I. Warnold
    • 2
  1. 1.Department of Surgery IIUniversity of GöteborgGöteborgSweden
  2. 2.Department of Clinical NutritionUniversity of GöteborgGöteborgSweden

Personalised recommendations