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Ann Surg. Feb 1993; 217(2): 185–195.
PMCID: PMC1242758

The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study.

Abstract

Three hundred patients undergoing major general surgical procedures were randomized by means of a computer-assisted algorithm to receive either total parenteral nutrition (TPN) from the first postoperative day or only prolonged glucose administration (250-300 g/day) up to 15 days after operation. All patients receiving TPN were treated individually based on daily measurements of energy and nitrogen balances. The treatment goal was to keep the patients in positive energy balance (+20%) and close to nitrogen balance. The effects of the two "nutrition regimens" on outcome such as mortality rate, complications, the need of additional medical support and patient-related functional disabilities were investigated. No selection of patients was made, that is, malnourished patients were also randomized. There were no differences among TPN versus glucose treatment when results were analyzed according to intent to treat. Approximately 60% of all patients were able to start eating within 8 to 9 days after operation. No differences were observed between such patients regardless of being treated with TPN or glucose only. Patients on glucose treatment during 14 days had a significantly higher mortality rate (p < 0.05) than patients on either continuous and uncomplicated TPN treatment or short-term glucose treatment. Similar results for mortality rates also were seen with regard to severe complications (cardiopulmonary problems, sepsis, and wound-healing insufficiencies), functional disturbances, the need of additional medical support, and abnormalities in nutritional state. Twenty per cent of the patients randomized to TPN treatment showed a statistical trend (p < 0.10) toward a higher mortality rate (36%) compared with patients randomized to prolonged glucose treatment (21% mortality rate). These patients could not be identified by evaluation of preoperative factors. Thus, the overall evaluation of the results makes it likely that a fraction of high-risk patients (approximately 20%) were not doing well on immediate postoperative intravenous feeding, and it is possible that TPN to such patients accentuated their morbidity rate. Although patients (20%) on prolonged semi-starvation (14 days glucose treatment) had increased mortality rate and severe complications, it was possible that undernutrition induced a slightly different complication scenario than induced by TPN in the high-risk patients. The results demonstrate that in most surgical patients (60%), postoperative semi-starvation is not a limiting factor for outcome. In remaining 40%, inadequate nutrition was associated with both increased morbidity and mortality rates. In this sense, inadequate nutrition represents both too much and too little, whereas overfeeding seemed to be a larger problem than underfeeding.(ABSTRACT TRUNCATED AT 400 WORDS)

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Selected References

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  • Windsor JA, Hill GL. Weight loss with physiologic impairment. A basic indicator of surgical risk. Ann Surg. 1988 Mar;207(3):290–296. [PMC free article] [PubMed]
  • Warnold I, Lundholm K. Clinical significance of preoperative nutritional status in 215 noncancer patients. Ann Surg. 1984 Mar;199(3):299–305. [PMC free article] [PubMed]
  • Dempsey DT, Mullen JL, Buzby GP. The link between nutritional status and clinical outcome: can nutritional intervention modify it? Am J Clin Nutr. 1988 Feb;47(2 Suppl):352–356. [PubMed]
  • Detsky AS, Baker JP, O'Rourke K, Goel V. Perioperative parenteral nutrition: a meta-analysis. Ann Intern Med. 1987 Aug;107(2):195–203. [PubMed]
  • Buzby GP, Williford WO, Peterson OL, Crosby LO, Page CP, Reinhardt GF, Mullen JL. A randomized clinical trial of total parenteral nutrition in malnourished surgical patients: the rationale and impact of previous clinical trials and pilot study on protocol design. Am J Clin Nutr. 1988 Feb;47(2 Suppl):357–365. [PubMed]
  • Askanazi J, Hensle TW, Starker PM, Lockhart SH, LaSala PA, Olsson C, Kinney JM. Effect of immediate postoperative nutritional support on length of hospitalization. Ann Surg. 1986 Mar;203(3):236–239. [PMC free article] [PubMed]
  • Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics. 1975 Mar;31(1):103–115. [PubMed]
  • Lundholm K, Bennegård K, Wickström I, Lindmark L. Is it possible to evaluate the efficacy of amino acid solutions after major surgical procedures or accidental injuries? Evaluation in a randomized and prospective study. JPEN J Parenter Enteral Nutr. 1986 Jan-Feb;10(1):29–33. [PubMed]
  • Mullen JL, Buzby GP, Waldman MT, Gertner MH, Hobbs CL, Rosato EF. Prediction of operative morbidity and mortality by preoperative nutritional assessment. Surg Forum. 1979;30:80–82. [PubMed]
  • Casey J, Flinn WR, Yao JS, Fahey V, Pawlowski J, Bergan JJ. Correlation of immune and nutritional status with wound complications in patients undergoing vascular operations. Surgery. 1983 Jun;93(6):822–827. [PubMed]
  • Woolfson AM, Smith JA. Elective nutritional support after major surgery: a prospective randomised trial. Clin Nutr. 1989 Feb;8(1):15–21. [PubMed]
  • Shizgal HM, Vasilevsky CA, Gardiner PF, Wang WZ, Tuitt DA, Brabant GV. Nutritional assessment and skeletal muscle function. Am J Clin Nutr. 1986 Dec;44(6):761–771. [PubMed]
  • Drott C, Ekman L, Holm S, Waldenström A, Lundholm K. Effects of tumor-load and malnutrition on myocardial function in the isolated working rat heart. J Mol Cell Cardiol. 1986 Nov;18(11):1165–1176. [PubMed]
  • Drott C, Waldenström A, Lundholm K. Cardiac sensitivity and responsiveness to beta-adrenergic stimulation in experimental cancer and undernutrition. J Mol Cell Cardiol. 1987 Jul;19(7):675–683. [PubMed]
  • Ransnäs L, Drott C, Lundholm K, Hjalmarson A, Jacobsson B. Effects of malnutrition on rat myocardial beta-adrenergic and muscarinic receptors. Circ Res. 1989 May;64(5):949–956. [PubMed]
  • Thurston J, Marks P. Electrocardiographic abnormalities in patients with anorexia nervosa. Br Heart J. 1974 Jul;36(7):719–723. [PMC free article] [PubMed]
  • Crandall DL, Lai FM, Huggins FJ, Tanikella TK, Cervoni P. Effect of caloric restriction on cardiac reactivity and beta-adrenoceptor concentration. Am J Physiol. 1983 Mar;244(3):H444–H448. [PubMed]
  • Heymsfield SB, Bethel RA, Ansley JD, Gibbs DM, Felner JM, Nutter DO. Cardiac abnormalities in cachectic patients before and during nutritional repletion. Am Heart J. 1978 May;95(5):584–594. [PubMed]
  • Isner JM, Sours HE, Paris AL, Ferrans VJ, Roberts WC. Sudden, unexpected death in avid dieters using the liquid-protein-modified-fast diet. Observations in 17 patients and the role of the prolonged QT interval. Circulation. 1979 Dec;60(6):1401–1412. [PubMed]

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