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?

  • Harry Salinas
  • Abdulmentin Dursun
  • Ioannis Konstantinidis
  • Deanna Nguyen
  • Paul Shellito
  • Richard Hodin
  • Liliana Bordeianou
Original Article

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 disease Ulcerative colitis Colorectal surgery Nutrition 

References

  1. 1.
    Dempsey DT, Mullen JL, Buzby GP (1988) The link between nutritional status and clinical outcome: can nutritional intervention modify it? Am J Clin Nutr 47:352–356PubMedGoogle Scholar
  2. 2.
    Heyland DK, Montalvo M, MacDonald S et al (2001) Total parenteral nutrition in the surgical patient: a meta-analysis. Can J Surg 44:102–111PubMedGoogle Scholar
  3. 3.
    The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group (1991) Perioperative total parenteral nutrition in surgical patients. N Engl J Med 325:525–532CrossRefGoogle Scholar
  4. 4.
    Fan ST, Lo CM, Lai EC et al (1994) Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. N Engl J Med 331:1547–1552PubMedCrossRefGoogle Scholar
  5. 5.
    Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRefGoogle Scholar
  6. 6.
    Gawande AA, Kwaan MR, Regenbogen SE et al (2007) An Apgar score for surgery. J Am Coll Surg 204:201–208PubMedCrossRefGoogle Scholar
  7. 7.
    Weimann A, Braga M, Harsanyi L et al (2006) ESPEN Guidelines on Enteral Nutrition: surgery including organ transplantation. Clin Nutr 25:224–244PubMedCrossRefGoogle Scholar
  8. 8.
    Rombeau JL, Barot LR, Williamson CE et al (1982) Preoperative total parenteral nutrition and surgical outcome in patients with inflammatory bowel disease. Am J Surg 143:139–143PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Harry Salinas
    • 1
  • Abdulmentin Dursun
    • 1
  • Ioannis Konstantinidis
    • 1
  • Deanna Nguyen
    • 2
  • Paul Shellito
    • 3
  • Richard Hodin
    • 3
  • Liliana Bordeianou
    • 3
    • 4
  1. 1.Department of SurgeryMassachusetts General HospitalBostonUSA
  2. 2.Department of GastroenterologyCrohn’s and Colitis Center at Massachusetts General HospitalBostonUSA
  3. 3.Department of SurgeryCrohn’s and Colitis Center at Massachusetts General HospitalBostonUSA
  4. 4.Department of SurgeryMassachusetts General Hospital Crohn’s and Colitis CenterBostonUSA

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