title: Does preoperative total parenteral nutrition in patients with ulcerative colitis produce better outcomes?
abstract: OBJECTIVE
  Malnutrition is a frequent problem in patients with ulcerative colitis (UC) leading to increased postoperative complication rates. Preoperative total parenteral nutrition (TPN) has been shown to reduce complications in some subgroups of patients, but has not been studied in UC. We investigated the impact of preoperative TPN on postoperative complication rates in patients undergoing surgery for UC.
  
  
  METHODS
  This paper is a review of 235 patients who underwent surgery for UC; 56 received preoperative TPN and 179 did not. Postoperative complication rates were compared.
  
  
  RESULTS
  Both had similar rates of anastomotic leak (5.4 vs. 2.8 %, p = 0.356), infection (12.5 vs. 20.1 %, p = 0.199), ileus/bowel obstruction (21.4 vs. 15.6 %, p = 0.315), cardiac complications (3.6 vs. 0 %, p = 0.056), wound dehiscence (3.6 vs. 1.7 %, p = 0.595), reoperation (10.7 vs. 3.9 %, p = 0.086), and death (1.8 vs. 0 %, p = 0.238). The TPN group was more malnourished (albumin 2.49 vs. 3.45, p < 0.001), more often on steroids (83.9 vs. 57.5 %, p < 0.001), had more emergent surgery (10.7 vs. 3.4 %, p = 0.029), more severe colitis (89.3 vs. 65.9 %, p = 0.001), and lower Surgical Apgar Score (6.15 vs. 6.57, p = 0.033). After controlling for these with logistic regression, the TPN group still had higher complication rates (OR 2.32, p = 0.04). When line infections were excluded, TPN did not significantly affect outcomes (OR 1.5, p = 0.311)
  
  
  CONCLUSIONS
  There were no differences in postoperative complications when line infections were excluded. Our data does not support routine preoperative TPN in patients with UC. However, it may lead to equal surgical outcomes in the sickest and most malnourished patients at the cost of line-related morbidity.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Harry
authors.initials: H
authors.lastname: Salinas
authors.forename: Abdulmentin
authors.initials: A
authors.lastname: Dursun
authors.forename: Ioannis
authors.initials: I
authors.lastname: Konstantinidis
authors.forename: Deanna
authors.initials: D
authors.lastname: Nguyen
authors.forename: Paul
authors.initials: P
authors.lastname: Shellito
authors.forename: Richard
authors.initials: R
authors.lastname: Hodin
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D016896:Treatment Outcome; D055815:Young Adult