The effects of perioperative total parenteral nutrition on postoperative mortality and morbidity: Perioperatif total parenteral nutrisyonun postoperatif morbidite ve mortalite üzerine etkileri

İlyas  Başkonuş; Ersin Borazan; Göktürk Maralcan; Necdet Aybastı; Avni Gökalp; Ahmet A. Balık

doi:10.5455/GMJ-30-2011-51

Authors

İlyas Başkonuş Gaziantep Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Gaziantep
Ersin Borazan Gaziantep Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Gaziantep
Göktürk Maralcan Gaziantep Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Gaziantep
Necdet Aybastı Gaziantep Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Gaziantep
Avni Gökalp Gaziantep Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Gaziantep
Ahmet A. Balık Gaziantep Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Gaziantep

DOI:

https://doi.org/10.5455/GMJ-30-2011-51

Keywords:

Cancer, morbidity, mortality, nutritional assessment, perioperative nutrition

Abstract

It is known that postoperative complication ratios at severely malnourished patients were higher than nonseverely malnourished patients according to the data in literature reviews. The goal of this prospective study is to investigate the effects of per ioperative nutritional support on postoperative morbidity and mortality in severely malnourished gastrointestinal tract cancer patients. Seventyone patients with the diagnosis of gastrointestinal tract cancer were included in this study. Subjective Global Assessment index was applied for patients’ nutritional state. The patients were divided into two groups, severely malnourished (Group 1) and nonseverely malnourished (Group 2: well-nourished and mildly malnourished). The daily energy requirement of 36 patients in Group 1 was calculated and total parenteral nutrition was applied 30-35 kcal/kg/day by average for preoperative 7 days and postoperative 3 days to these 36 patients. Perioperative total parenteral nutrition was not given to 35 patients in Group 2. Patient morbidity and mortality was followed during the hospitalization period. Total morbidity was defined as; major complications, minor complications and complications related to total parenteral nutrition. Major complications occurred in 7 patients (19.41%) in Group 1 and 6 patients (17.11%) in Group 2 (p=0.80). Total morbidity was in 16 patients (44.40%) in Group 1, and 17 patients (48.57%) in Group 2 (p=0.727). Mortality was seen as one patients in each group postoperatively. In this study, it was concluded that morbidity and mortality ratio of severely malnourished patients can be decreased to the morbidity and mortality ratio of nonseverely malnourished patients with perioperative nutrition.

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References

Norton JA, Thom AK. Parenteral nutrition and the patient with cancer. In:Rombeau JL. Clininal nutrition, parenteral nutrition (2nd ed.) Philadelphia, WB Saunders Com, 1993; 512-37.

Gianotti L. Cerrahide beslenme desteği. In: Sayek İ. Temel Cerrahi (3. Baskı). Ankara, Güneş Kitapevi. 2004; 125-136.

Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients. JAMA 1976;235(15):1567-70.

Hill GL, Blackett RL, Pickford I, Burkinshaw L, Young GA, Warren JV, et al. Malnutrition in surgical patients. An unrecognised problem. Lancet 1977;1(8013):689-92.

Gündoğdu H. Cerrahi hastada beslenme desteği. Cerrahi Tıp Bilimleri Derg 2000;3:3-21.

Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Rognostic nutritional index in gastrointestinal surgery. Am J Surg 1980;139(1):160-7.

Palesty JA, Dudrick SJ. What we have learned about cachexia in gastrointestinal cancer. Dig Dis 2003;21(3):198-213.

Holter AR, Fischer JE. The effects of perioperative hyperalimentation on complications in patients with carcinoma and weight loss. J Surg Res 1977;23(1):31-4.

Heatley RV, Williams RH, Lewis MH. Preoperative intravenous feeding. A controlled trial. Postgrad Med J 1979;55(646):541-5.

Thompson BR, Julian TB, Stemple JF. Perioperative total parenteral nutrition in patients with gastrointestinal cancer. J Surg Res 1981;30(5):497-500.

Müller JM, Brenner U, Dienst C, Pichlmaier H. Preoperative parenteral feeding in patients with gastrointestinal carcinoma. Lancet 1982;1(8263):68-71.

The Veterans affairs total parenteral nutrition cooperative study group. Perioperative total parenteral nutrition in surgical patients. N Eng J Med 1991;325(8):525-32.

Dempsey DT, Mullen JL, Buzby GP. The link between nutritional status and clinical outcome: can nutritional intervention modify it? Am J Clin Nutr 1988;47(2 Suppl):352-6.

Ockenga J, Pirlich M, Gastell S, Lochs H. Tumour anorexiatumour cachexia in case of gastrointestinal tumours: standards and vision. Z Gastroentorol 2002;40(11):929-36.

Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status. JPEN J Parenter Enteral Nutr 1987;11(1):8- 13.

Sungurtekin H, Sungurtekin M, Hancı V, Erdem E. Comparison of two nutrition assessment techniques in hospitalized patients. Nutrition 2004;20(5):428-32.

Gupta D, Lis CG, Vashi PG, Grutsch JF, Burrows J, Becker J, et al. The subjective global assessment (SGA) as a prognostic indicator in patients with advanced colorectal cancer. Proc Am Soc Clin Oncol 2003; 22: (abstr 1204).

Ulander K, Lundgren PO, Grahn G, Jeppsson B. Preoperative nutritional assessment of patients with colorectal cancer. Eur J Cancer 1995:31(Supplement 6):S276.

Norman K, Schütz T, Kemps M, Josef Lübke H, Lochs H, Pirlich M. The subjective global assessment reliably identifies malnutrition-related muscle dysfunction. Clin Nutr 2005;24(1):143-50.

Kuyumcu A, Polat-Düzgün A, Uzun S, Özmen MM, Coşkun F, Besler HT. Major abdominal cerrahi geçiren hastalarda preoperatif nutrisyonel değerlendirme: ileri yaş radikal cerrahiye engel midir? Türk Geriatri Dergisi 2003;6(4):128-34.

Jeejeebhoy KN. Total parenteral nutrition: potion or poison? Am J Clin Nutr 2001;74(2):160-3.

Iapichino G, Rossi C, Radrizzani D, Simini B, Albicini M, Ferla L, et al. Nutrition given to critically ill patients during high level/complex care (on Italian ICUs). Clin Nutr 2004;23(3):409- 16.

Dudrick SJ, Copeland EM, MacFadyen BV. Parenteral nutrition as an adjunct to cancer therapy. Klin Anasth Intensivmed 1977;13:1-12.

Bozetti F. Perioperatif nutrition of patients with gastrointestinal cancer. Br J Surg 2002;89(10):1201-2.

Braga M, Gianotti L, Nespoli L, Radaelli G, Di Carlo V. Nutritional approach in malnourished surgical patients: a prospective randomized study. Arch Surg 2002;137(2):174-80.

Hill GL, King RF, Smith RC, Smith AH, Oxby CB, Sharafi A, et al. Multi-element analysis of the living body by neutron activation analysis-application to critically ill patients receiving intravenous nutrition. Br J Surg 1979;66(12):868-72.

Blackburn GL. Hyperalimentation in the critically ill patient. Heart Lung 1979;8(1):67-70.

Bellantone R, Doglietto GB, Bossola M, Pacelli F, Negro F, Sofo L, et al. Preoperatif parenteral nutrition in the high risk surgical patient. JPEN J Parenter Enteral Nutr 1988;12(2):195- 7.

Heyland DK, Montalvo M, MacDonald S, Keefe L, Su XY, Drover JW. Total parenteral nutrition in the surgical patient: a meta-analysis. Can J Surg 2001;44(2):102-11.

Von Meyenfeldt MF, Meijerink WJ, Rouflart MM, Builmaassen MT, Soeters PB. Perioperative nutritional support: a randomised clinical trial. Clin Nutr 1992;11(4):180-6.

van den Berg A, van Elburg RM, Westerbeek EA, Twisk JW, Fetter WP. Glutamine-enriched enteral nutrition in very-lowbirth- weight infants and effects on feeding tolerance and infectious morbidity: a randomized controlled trial. Am J Clin Nutr 2005;81(6):1397-404.

Fuentes-Orozco C, Anaya-Prado R, González-Ojeda A, Arenas- Márquez H, Cabrera-Pivaral C, Cervantes-Guevara G, et al. Lalanyl- L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. Clin Nutr 2004; 23(1):13-21.