Abstract
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.
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Studley HO (1936) Percentage of weight loss. A Basic indicator of surgical risk in patients with chronic peptic ulcer. JAMA 106:458–460
Mullen JL, Gertner MH, Buzby GP, Goodhart GL, Rosato EF (1979) Implications of malnutrition in the surgical patient. Arch Surg 114:121–125
Warnold I, Lundholm K (1984) Clinical significance of preoperative nutritional status in 215 non-cancer patients. Ann Surg 199:299–305
Irvin TT, Goligher JC (1973) Aetiology of disruption of intestinal anastomoses. Br J Surg 60:461–464
Irvin TT, Hunt TK (1974) Effect of malnutrition on colonic healing. Ann Surg 180:765–772
Buzby G, Mullen J, Matthews D, Hobbs C (1980) Prognostic nutritional index in gastrointestinal surgery. Am J Surg 139: 160–167
Klidjian AM, Foster KI, Kammerling RM, Cooper A, Karran SJ (1980) Relation of anthropometric and dynamometric variables to serious postoperative complications. Br Med J 281:899–901
Ryan JA Jr, Taft DA (1981) Preoperative nutritional assessment does not predict morbidity and mortality in abdominal operations. Surg Forum 31:96–98
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 8:153–159
Koretz R (1984) What supports nutritional support? Dig Dis Sci 29:577–588
Talstad J, Gjone E (1976) The disease activity of ulcerative colitis and Crohn's disease. Scand J Gastroenterol 11:403–408
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 40:461–473
Symreng T (1982) Arm anthropometry in a large reference population and in surgical patien ts. Clin Nutr 1:211–219
Siegel S (1956) Nonparametric statistics. Mc Graw-Hill Kogakusha, Tokyo
Higgens CS, Keighley MRB, Allan RN (1981) Impact of preoperative weight loss on postoperative morbidity. J R Soc Med 74:571–573
Freeman M, Frankmann C, Bech J, Valdiviero M (1982) Prognostic nutritional factors in lung cancer patients. JPEN 6:122–127
Forse AR, Shizgal HM (1980) The assessment of malnutrition. Surgery 88:17–24
Seltzer M, Fletcher S, Slocum B, Engler P (1981) Instant nutritional assessment in the intensive care unit. JPEN 5:70–72
Harvey K, Moldarver L, Bistrian B, Blackburn G (1981) Biological measures for the formulation of a hospital prognostic index. Am J Clin Nutr 34:2013–2022
Golden M (1982) Transport proteins as indices of protein status. Am J Clin Nutr 35:1159–1165
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 London
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: 405–415
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 London
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 146:519–526
Christiansen L, Fischerman K, Lykkegaard Nielsen M (1973) Early complications after surgical treatment of Crohn's disease. Scand J Gastroenterol 8:651–656
Higgens C, Allan KN, Keighley MRB, Arabi Y, Alexander-Williams J (1980) Sepsis following operation for inflammatory bowel disease. Dis Colon Rectum 23:102–105
Holter AR, Fischer JE (1977) The effects of perioperative hyperalimentation on complications in patients with carcinoma and weight loss. J Surg Res 23:31–34
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 64:125–128
Collins FP, Oxby CB, Hill GL (1978) Intravenous aminoacids and intravenous hyperalimentation as protein-sparing therapy after major surgery. Lancet 1:788–791
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 22:437–439
Heatley RV, Williams RH, Lewis MH (1979) Pre-operative intravenous feeding. A controlled trial. Postgrad Med J 55: 541–545
Thompson BR, Julian TB, Stremple JF (1981) Perioperative total parenteral nutrition in patients with gastrointestinal cancer. J Surg Res 30:497–500
Simms JM, Oliver E, Smith JAR (1980) A Study of total parenteral nutrition (TPN) in major gastric and esophageal resection for neoplasia. JPEN 4:422
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 68:69–72
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 5:360
Müller JM, Dienst C, Brenner U, Pichlmaier H (1982) Preoperative parenteral feeding in patients with gastrointestinal carcinoma. Lancet 1:68–71
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 6:335
Jensen St, Ginnerup P (1982) Total parenteral ernaering perioperativt til patienter med adenocarcinoma recti. Ugeskr Laeger 144:460–463
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 114
Müller JM, Keller HW, Brenner U, Walter M, Holzmüller W (1986) Indications and effects of pre-operative parenteral nutrition. World J Surg 10:53–63
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Fasth, S., Hultén, L., Magnusson, O. et al. Postoperative complications in colorectal surgery in relation to preoperative clinical and nutritional state and postoperative nutritional treatment. Int J Colorect Dis 2, 87–92 (1987). https://doi.org/10.1007/BF01647698
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DOI: https://doi.org/10.1007/BF01647698