Pre-operative total parenteral nutrition improves post-operative outcomes in a subset of Crohn's disease patients undergoing major abdominal surgery

Fares Ayoub; Amir Y Kamel; Ahmed Ouni; Naueen Chaudhry; Yan Ader; Sanda Tan; Atif Iqbal; Ellen M Zimmermann; Sarah C Glover

doi:10.1093/gastro/goy033

Pre-operative total parenteral nutrition improves post-operative outcomes in a subset of Crohn's disease patients undergoing major abdominal surgery

Gastroenterol Rep (Oxf). 2019 Apr;7(2):107-114. doi: 10.1093/gastro/goy033. Epub 2018 Sep 4.

Authors

Fares Ayoub¹, Amir Y Kamel², Ahmed Ouni¹, Naueen Chaudhry³, Yan Ader², Sanda Tan⁴, Atif Iqbal⁴, Ellen M Zimmermann³, Sarah C Glover³

Affiliations

¹ Department of Medicine, University of Florida, Gainesville, FL, USA.
² Department of Pharmacy, University of Florida, Gainesville, FL, USA.
³ Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Florida, Gainesville, FL, USA.
⁴ Department of Surgery, University of Florida, Gainesville, FL, USA.

Abstract

Background: Despite major advances in the medical management of Crohn's disease (CD), a significant proportion of patients will require surgery within 5 years of diagnosis. Malnutrition is an independent risk factor for adverse post-operative outcomes following gastrointestinal surgery. Data on the value of pre-operative total parenteral nutrition (TPN) in CD patients are mixed and there is a paucity of data in the biologic era. We aimed to define the role of pre-operative TPN in this population.

Methods: This was a retrospective cohort study conducted at a tertiary referral center. CD patients who underwent major abdominal surgery were identified. Patients receiving pre-operative TPN were compared to controls. We compared the incidence of 30-day infectious and non-infectious post-operative complications between the two groups.

Results: A total of 144 CD patients who underwent major abdominal surgery between March 2007 and March 2017 were included. Fifty-five patients who received pre-operative TPN were compared to 89 controls. Twenty-one (14.6%) patients developed infectious complications (18.2% in TPN group vs 12.3% in non-TPN group, P = 0.34) and 23 (15.9%) developed non-infectious complications (14.5% in TPN group vs 16.9% in non-TPN group, P = 0.71). In a multivariate analysis, controlling for differences in baseline disease severity and malnutrition between groups, patients receiving pre-operative TPN for ≥60 days had significantly lower odds of developing non-infectious complications (odds ratio 0.07, 95% confidence interval: 0.01-0.80, P = 0.03). Weight loss of >10% in the past 6 months was a significant predictor of post-operative complications.

Conclusions: In a subset of malnourished CD patients, TPN is safe and allows comparable operative outcomes to controls. Pre-operative TPN for ≥60 days reduced post-operative non-infectious complications without associated increase in infectious complications.

Keywords: Crohn’s disease; post-operative complications; pre-operative malnutrition; total parenteral nutrition.