title: Preoperative exclusive enteral nutrition reduces the postoperative septic complications of fistulizing Crohn's disease.
abstract: OBJECTIVE
  Exclusive enteral nutrition (EEN) has been shown to be effective in the management of Crohn's disease (CD). However, few experiences have been reported regarding its role in postoperative intra-abdominal septic complications (IASCs) after bowel resections for enterocutaneous fistulas (ECFs). Our aim was to investigate the influence of preoperative 3-month EEN on the incidence of IASCs and to clarify the risk factors of IASCs in fistulizing CD.
  
  
  METHODS
  A retrospective study on 123 CD patients suffering from ECFs was conducted from February 2001 to April 2011. Fifty-five patients (44.7%) received preoperative 3-month EEN. The changes in serum albumin and C-reactive protein (CRP) were compared. Perioperative data were analyzed using logistic regression to identify the independent risk factors affecting the incidence of postoperative IASCs.
  
  
  RESULTS
  Patients were similar in gender, age, fistula conditions and perioperative medications in the EEN and non-EEN groups. The EEN group had a significantly higher serum albumin level and lower CRP at operation, and suffered a lower risk of IASCs (3.6% vs 17.6%, P<0.05). Two years after operation when follow-up ended, the two groups had comparable cumulative risk of IASCs (P=0.109). A logistic regression analysis identified age at operation and preoperative EEN as independent risk factors of postoperative IASCs.
  
  
  CONCLUSIONS
  Preoperative EEN reduced the risk of postoperative IASCs after operation for ECFs in CD. In addition, age at operation may be another factor of influence.
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: G
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: J
authors.initials: J
authors.lastname: Ren
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: G
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: D
authors.initials: D
authors.lastname: Hu
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: G
authors.initials: G
authors.lastname: Gu
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: S
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: H
authors.initials: H
authors.lastname: Ren
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: X
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: J
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D003424:Crohn Disease / Q000628:therapy*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007412:Intestinal Fistula / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein