Perioperative total parenteral nutrition in surgical patients

Article Abstract:

Although major surgery is never completely free of risk, certain factors can significantly increase the risk incurred by a patient undergoing surgery. One of these is malnutrition; malnourished patients have a higher rate of postoperative complications and death. It has been suggested that preoperative nutritional support for the patient might improve his outcome. Usually such nutritional support would come in the form of total parenteral nutrition (TPN), in which all the patient's nutritional requirements are infused in solution directly into his blood. However, some studies found no improvement in surgical outcome when this nutritional support was given before surgery. To examine more closely the potential risks and benefits of TPN nutrition for malnourished patients before surgery, a study was conducted of 395 malnourished patients. All were scheduled to undergo surgery that involved either opening the chest or abdominal cavity. All patients received a thorough and objective evaluation of their nutritional state. TPN, begun one or two weeks prior to surgery and continuing three days after surgery, was given to 192 randomly selected patients. The remainder received no parenteral nutrition. The overall rate of complications was similar in both groups, although the group receiving TPN experienced more infectious complications and the control group experienced more noninfectious complications. The mortality rates for the two groups were similar. At the end of 90 days, 13.4 percent of the TPN group died, as did 10.5 percent of the control group. However, when only the severely malnourished patients were considered, the rate of noninfectious complications was much lower in the group that received TPN. The difference, although large, was not statistically significant. This presumably was due to the relatively small size of the subset of patients who met criteria for severe malnutrition. These results suggest that for most malnourished patients TPN provides no benefit. However, for the minority of patients who are severely malnourished, the additional nutritional support may provide an advantage. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Parenteral nutrition - is it helpful?

Article Abstract:

It is well established that patients with poor nutrition suffer an increased rate of complications after surgery, as well as a slower rate of healing and recovery from infection. It appears to be obvious that providing additional nutritional support for malnourished patients prior to surgery would benefit them; parenteral nutritional support is widely used in hospitals around the nation. (Parenteral nutrition is not given through the digestive system; in most cases a nutritional solution is infused directly into a vein.) However, like so many things considered to be obvious, it may not be true. Several small studies have previously failed to confirm a significant benefit from the use of parenteral nutrition for malnourished patients. The size of these studies has prevented any firm conclusions to be drawn. However, researchers have now reported the results of a major study on parenteral nutritional support in malnourished patients undergoing major surgery. In the August 22, 1991 of The New England Journal of Medicine, the researchers report that patients who received parenteral nutrition were no better off after surgery than those who did not. Furthermore, the study confirmed the previous observation that parenteral nutrition carries with it an increased risk of infection. An analysis of subgroups of patients suggested that, while the overall group of patients did not benefit, the most severely malnourished patients derived some benefit. However, this observation was not statistically significant. Parenteral nutrition requires an increased hospital stay and an increased risk for infection. As compelling as the logic might be to provide nutritional support for malnourished patients, it is difficult to recommend such a procedure in the absence of evidence for some benefit. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, editorial

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A twist of fate?

Article Abstract:

A case study of thirty nine year old Sri Lankan male who was admitted with symptoms of headache, chills, diarrhea, nausea, vomiting and neck stiffness is presented. The patient suspected a fish poisoning so it was difficult to arrive at a diagnosis immediately.

Commercial Fishing, Fishing, Edible Fish, Case studies, Risk factors, Fish as food, Fish (Food product), Food poisoning

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