[Morbidity and mortality from ileal duct and its relationship with post-surgical total parenteral nutrition].
BACKGROUND
The frequency of complications and early death in patients with hyponutrition and total radical cystectomy with ileal duct is high. The role of artificial nutritional support on short-term outcomes is still controversial.


OBJECTIVE
to determine whether total parenteral nutrition reduces the frequency of complications and death when it is administered during the immediate post-surgical period.


METHODS
cohort study.


METHODS
third-level reference hospital.


METHODS
One hundred and fourteen consecutive patients having radical cystectomy and ileal duct between January of 2000 and June of 2004.


METHODS
Eight-one patients received post-surgical total parenteral nutrition for an average of 9.2 days, and 33 controls received 5% dextrose solution + 0.9% saline solution. MAIN RESULTS AND MEASUREMENTS: thirty-six (31.6%) patients had complications and 11 (9.6%) died. The main death-related complications were of surgical origin. After a multiple regression multivariate analysis, and according to risk and nutritional intervention, an important reduction of early death was found in the group with severe hyponutrition (RR = 0.09; 95% CI = 0.02-0.33; p = 0.008). Anastomosis dehiscence in the presence of abdominal sepsis was the most important predictive factor of early death (RR = 5.0; 95% CI = 1.45-17.3; p = 0.007).


CONCLUSIONS
The group with no hyponutrition or with mild hyponutrition does not benefit from post-surgical total parenteral nutrition.
Gonzĺez Avila
G
G
Departamento de Medicina Interna, Hospital de Oncologia, CMN Siglo XXI, México. gabriel.gonzaleza@imss.gob.mx
Rodríguez Ovalle
H
H
Rojas Barrera
J A
JA
D000368:Aged; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D015999:Multivariate Analysis; D010289:Parenteral Nutrition, Total; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D012044:Regression Analysis; D013997:Time Factors; D014547:Urinary Diversion / Q000009:adverse effects / Q000401:mortality*