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Accepted manuscript

Impact of total parenteral nutrition versus 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
Affiliation:
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, China
Lei Cao
Affiliation:
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, China
Yusheng Chen
Affiliation:
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, China
Tianrun Song
Affiliation:
Department of General Surgery, Jinling Clinical School of Medicine (Eastern Theater General Hospital), Nanjing Medical University, No. 305 East Zhongshan Road, Nanjing 210002, China
Zhen Guo
Affiliation:
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, China
Weiming Zhu*
Affiliation:
IBD therapeutic center, Nanjing University of Chinese medicine
Yi Li*
Affiliation:
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, China
*
*Correspondence: Yi Li, M.D., Ph.D. Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China. Email: liyi.jlh@hotmail.com Tel.: +86 25 84806839; fax: +86 25 84806839;Weiming Zhu, MD. IBD therapeutic center, Nanjing University of Chinese medicine. Email: yfy135@njucm.edu.cn
*Correspondence: Yi Li, M.D., Ph.D. Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China. Email: liyi.jlh@hotmail.com Tel.: +86 25 84806839; fax: +86 25 84806839;Weiming Zhu, MD. IBD therapeutic center, Nanjing University of Chinese medicine. Email: yfy135@njucm.edu.cn
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Abstract

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Achieving optimal nutritional status in patients with penetrating Crohn’s disease (CD) is crucial in preparing for surgical resection. However, there is a dearth of literature comparing the efficacy of total parenteral nutrition (TPN) versus exclusive enteral nutrition (EEN) in optimizing postoperative outcomes. Hence, we conducted a case-matched study to assess the impact of preoperative EEN versus TPN on the incidence of postoperative adverse outcomes, encompassing overall postoperative morbidity and stoma formation, among penetrating CD patients undergoing bowel surgery. From December 1, 2012 to December 1, 2021, a retrospective study was conducted at a tertiary center to enroll consecutive patients with penetrating CD who underwent surgical resection. Propensity score matching (PSM) was utilized 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 to pre-optimization levels. After matching, TPN was increased occurrence of postoperative adverse outcomes (92.2% vs. 64.1%, p = 0.001) when compared to EEN group. In the multivariate analysis, TPN showed a significantly higher odds ratio for adverse outcomes than EEN (OR = 4.241; 95% CI 1.567-11.478; p = 0.004). The study revealed that penetrating CD patients who were able to fulfill their nutritional requirements through EEN exhibited superior nutritional and surgical outcomes in comparison to those who received TPN.

Type
Research Article
Copyright
© The Authors 2024

Footnotes

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The first three authors contributed equally to this work.