Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutrition

Abstract

ObjectiveThe effect of preoperative total parenteral nutrition (TPN) on the rate of early (within 30 days) postoperative complications in patients with moderate to severe Crohn's disease (CD) was examined.Material and methodsA series of 15 consecutive patients with CD (mean CD activity index score, 270) given preoperative TPN for 18–90 days (mean, 46 days) and undergoing bowel resection and primary anastomosis was compared with matching controls (105 patients) consecutively selected from all CD patients operated in Stockholm County during a preceding 20-year period without preoperative TPN.ResultsDuring the preoperative TPN, all the patients studied displayed clinical remission of CD as reflected in improvement in their general well-being, relief of abdominal pain, and abatement of fever and diarrhea. There was no significant early postoperative complication in the TPN-treated group, whereas there were 29 patients with early postoperative complications in the control group, which means a significantly higher rate of postoperative complications when preoperative TPN was not provided. During the preoperative TPN, some crucial variables increased such as the body weight, the serum concentrations of albumin and triiodothyronine reflecting improved nutritional state, whereas the serum concentration of haptoglobin and the white cell count decreased reflecting decreased inflammatory activity.ConclusionsThis study shows that preoperative TPN for at least 18 days may be recommended to be given to patients with moderate to severe CD until clinical remission is achieved in order to minimize the risk of early postoperative complications.

Perioperative Parenteral Nutrition in Adults With Inflammatory Bowel Disease

“…Another study addressed CDAI scores, indicating that the group receiving preoperative PN had reductions in CDAI to the point of clinical remission by the date of surgery. 45 CDAI was not calculated for control subjects in this study, and statistical significance was not reported for clinical improvement among the PN subjects. One study also concluded that preoperative PN was associated with a smaller length of small bowel requiring resection, confirming earlier findings.…”

“…Two of the 4 primary articles did not provide information on PN composition. 42,45 Similar to oral intake, PN composition has the potential to alter clinical outcomes significantly; PN composition is also simple data to collect. Controlling for PN composition may be challenging, as patients will likely have different nutrition needs, but documenting what is provided would give better insight into the study context.…”

“…45 The link between central venous catheter use and risk for bloodstream infections (BSI) has been well established. 47,48 Tunnelled catheters have historically been accepted to offer a lower infection risk than nontunnelled catheters, although this convention has recently come under debate.…”

“…Jacobson 45 (n = 120) found a significant reduction in postoperative complications among patients with CD undergoing intestinal resection who received preoperative PN, as compared with patients who did not receive PN (P < .05). Control subjects were matched to PN subjects (7:1) based on baseline characteristics.…”

Preoperative Nutritional Optimization for Crohn’s Disease Patients Can Improve Surgical Outcome

“…Although this study confirmed the association of hypoalbuminemia with anastomotic leak, no prospective studies have conclusively demonstrated that preoperative protein replenishment reduces the risk of anastomotic leak. Jacobson [11] examined the role of pre-operative nutrition prior to surgery but lacked an appropriately matched control group and committed data about fistulas and abscess in the 2 groups. Other studies, including one by Zerbib et al [12], included many interventions at the same time – making it difficult to correlate the outcome with intervention.…”