Associations between early parenteral nutrition and in-hospital outcomes in underweight patients with gastrointestinal surgery.

Abstract

Guidelines recommend early parenteral nutrition for malnourished patients. However, the effectiveness of early parenteral nutrition in underweight patients has not been established. This study aimed to determine whether in-hospital outcomes were associated with early parenteral nutrition in underweight gastrointestinal surgery patients with short-term contraindications to early enteral nutrition. We identified underweight adult gastrointestinal surgery patients with short-term contraindications to early enteral nutrition using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2018. We performed propensity-score overlap weighting to compare in-hospital outcomes between patients with and without early parenteral nutrition. The primary outcome was length of hospital stay. The secondary outcomes were total hospitalization cost, hospital-acquired pneumonia, hospital-acquired urinary tract infection, central line-associated bloodstream infection, and all-cause 28-day in-hospital mortality. We identified 31,898 eligible patients. Early parenteral nutrition was associated with longer hospital stay (19.2 vs. 18.4 days; difference, 0.7 days; 95% CI, 0.1 to 1.4). There were no differences between the patients with and without early parenteral nutrition in total hospitalization cost (difference, US$60; 95% CI,-277 to 397), hospital-acquired pneumonia (risk difference,-0.11%; 95% CI,-0.78 to 0.55), hospital-acquired urinary tract infection (risk difference, 0.03%; 95% CI,-0.08 to 0.14), central line-associated bloodstream infection (risk difference, 0.08%; 95% CI,-0.02 to 0.18), and all-cause 28-day in-hospital mortality (risk difference, 0.31%; 95% CI,-0.07 to 0.69). Early parenteral nutrition for underweight gastrointestinal surgery patients with short-term contraindications to early enteral nutrition was associated with longer hospital stay.