title: Utilization of parenteral nutrition following pancreaticoduodenectomy: is routine jejunostomy tube placement warranted?
abstract: BACKGROUND
  Complications following pancreaticoduodenectomy (PD) often necessitate nutritional support. This study analyzes the utilization of parenteral nutrition (TPN) during the surgical admission as evidence for or against routine jejunostomy placement.
  
  
  METHODS
  The California Cancer Registry (1994-2003) was linked to the California Inpatient File; PD for adenocarcinoma was performed in 1,873 patients. TPN use and enterostomy tube placement were determined and preoperative characteristics predictive of TPN use during the surgical admission were identified.
  
  
  RESULTS
  Fourteen percent of patients received TPN, 23% underwent enterostomy tube placement, and 63% received no supplemental nutritional support. TPN was associated with longer hospital stay (18 vs. 13 days, P < 0.0001). The Charlson Comorbidity Index (CCI) > or = 3 had nearly two-fold greater odds of receiving TPN (odds ratio [OR] = 1.85, P < 0.005).
  
  
  CONCLUSIONS
  Approximately 1 in 6 patients undergoing PD received TPN, which was associated with prolonged hospital stay. CCI > or = 3 was associated with increased odds of TPN utilization. Selected jejunostomy placement in patients with high CCI is worthy of consideration.
authors.affiliation: Department of Surgery, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA.
authors.forename: Irina
authors.initials: I
authors.lastname: Yermilov
authors.forename: Sushma
authors.initials: S
authors.lastname: Jain
authors.forename: Evan
authors.initials: E
authors.lastname: Sekeris
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Hines
authors.forename: Howard A
authors.initials: HA
authors.lastname: Reber
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: James S
authors.initials: JS
authors.lastname: Tomlinson
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000601:surgery*; D000368:Aged; D015897:Comorbidity; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D004766:Enterostomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period