Background:Despitemajor advances in themedicalmanagement of Crohn’s disease(CD),a significant proportion of patients will require surgery within 5 years of diagnosis.Malnutrition is an independent risk factor for adv...Background:Despitemajor advances in themedicalmanagement of Crohn’s disease(CD),a significant proportion of patients will require surgery within 5 years of diagnosis.Malnutrition is an independent risk factor for adverse post-operative outcomes following gastrointestinal surgery.Data on the value of pre-operative total parenteral nutrition(TPN)in CD patients aremixed and there is a paucity of data in the biologic era.We aimed to define the role of pre-operative TPN in this population.Methods:This was a retrospective cohort study conducted at a tertiary referral center.CD patients who underwent major abdominal surgery were identified.Patients receiving pre-operative TPN were compared to controls.We compared the incidence of 30-day infectious and non-infectious post-operative complications between the two groups.Results:A total of 144 CD patients who underwent major abdominal surgery between March 2007 and March 2017 were included.Fifty-five patients who received pre-operative TPN were compared to 89 controls.Twenty-one(14.6%)patients developed infectious complications(18.2%in TPN group vs 12.3%in non-TPN group,P=0.34)and 23(15.9%)developed noninfectious complications(14.5%in TPN group vs 16.9%in non-TPN group,P=0.71).In a multivariate analysis,controlling for differences in baseline disease severity and malnutrition between groups,patients receiving pre-operative TPN for60 days had significantly lower odds of developing non-infectious complications(odds ratio 0.07,95%confidence interval:0.01–0.80,P=0.03).Weight loss of>10%in the past 6 months was a significant predictor of post-operative complications.Conclusions:In a subset of malnourished CD patients,TPN is safe and allows comparable operative outcomes to controls.Pre-operative TPN for60 days reduced post-operative non-infectious complications without associated increase in infectious complications.展开更多
文摘Background:Despitemajor advances in themedicalmanagement of Crohn’s disease(CD),a significant proportion of patients will require surgery within 5 years of diagnosis.Malnutrition is an independent risk factor for adverse post-operative outcomes following gastrointestinal surgery.Data on the value of pre-operative total parenteral nutrition(TPN)in CD patients aremixed and there is a paucity of data in the biologic era.We aimed to define the role of pre-operative TPN in this population.Methods:This was a retrospective cohort study conducted at a tertiary referral center.CD patients who underwent major abdominal surgery were identified.Patients receiving pre-operative TPN were compared to controls.We compared the incidence of 30-day infectious and non-infectious post-operative complications between the two groups.Results:A total of 144 CD patients who underwent major abdominal surgery between March 2007 and March 2017 were included.Fifty-five patients who received pre-operative TPN were compared to 89 controls.Twenty-one(14.6%)patients developed infectious complications(18.2%in TPN group vs 12.3%in non-TPN group,P=0.34)and 23(15.9%)developed noninfectious complications(14.5%in TPN group vs 16.9%in non-TPN group,P=0.71).In a multivariate analysis,controlling for differences in baseline disease severity and malnutrition between groups,patients receiving pre-operative TPN for60 days had significantly lower odds of developing non-infectious complications(odds ratio 0.07,95%confidence interval:0.01–0.80,P=0.03).Weight loss of>10%in the past 6 months was a significant predictor of post-operative complications.Conclusions:In a subset of malnourished CD patients,TPN is safe and allows comparable operative outcomes to controls.Pre-operative TPN for60 days reduced post-operative non-infectious complications without associated increase in infectious complications.