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Impact of total parenteral nutrition v. exclusive enteral nutrition on postoperative adverse outcomes in patients with penetrating Crohn’s disease undergoing surgical resection: a retrospective cohort study

Published online by Cambridge University Press:  04 June 2024

Zhenya Sun ,
Lei Cao ,
Yusheng Chen ,
Tianrun Song ,
Zhen Guo ,
Weiming Zhu Open the ORCID record for Weiming Zhu [Opens in a new window]  and
Yi Li
Zhenya Sun
Affiliation:
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, People’s Republic of China
Lei Cao
Affiliation:
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, People’s Republic of China
Yusheng Chen
Affiliation:
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, People’s Republic of China
Tianrun Song
Affiliation:
Department of General Surgery, Jinling Clinical School of Medicine (Eastern Theater General Hospital), Nanjing Medical University, Nanjing 210002, People’s Republic of China
Zhen Guo
Affiliation:
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, People’s Republic of China
Weiming Zhu
Affiliation:
IBD Therapeutic Center, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
Yi Li*
Affiliation:
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, People’s Republic of China
*
*Corresponding author: Dr Yi Li, email liyi.jlh@hotmail.com
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Abstract

Achieving optimal nutritional status in patients with penetrating Crohn’s disease is crucial in preparing for surgical resection. However, there is a dearth of literature comparing the efficacy of total parenteral nutrition (TPN) v. exclusive enteral nutrition (EEN) in optimising postoperative outcomes. Hence, we conducted a case-matched study to assess the impact of preoperative EEN v. TPN on the incidence of postoperative adverse outcomes, encompassing overall postoperative morbidity and stoma formation, among penetrating Crohn’s disease patients undergoing bowel surgery. From 1 December 2012 to 1 December 2021, a retrospective study was conducted at a tertiary centre to enrol consecutive patients with penetrating Crohn’s disease who underwent surgical resection. Propensity score matching was utilised to compare the incidence of postoperative adverse outcomes. Furthermore, univariate and multivariate logistic regression analyses were conducted to identify the risk factors associated with adverse outcomes. The study included 510 patients meeting the criteria. Among them, 101 patients in the TPN group showed significant improvements in laboratory indicators at the time of surgery compared with pre-optimisation levels. After matching, TPN increased the occurrence of postoperative adverse outcomes (92·2 % v. 64·1 %, P = 0·001) when compared with the EEN group. In the multivariate analysis, TPN showed a significantly higher OR for adverse outcomes than EEN (OR = 4·241; 95 % CI 1·567–11·478; P = 0·004). The study revealed that penetrating Crohn’s disease patients who were able to fulfil their nutritional requirements through EEN exhibited superior nutritional and surgical outcomes in comparison with those who received TPN.

Keywords

Crohn’s diseaseTotal parenteral nutritionExclusive enteral nutritionPostoperative complications
Type
Research Article
Information
British Journal of Nutrition , First View , pp. 1 - 10
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Nutrition Society

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Footnotes

†

These authors contributed equally to this work.

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