Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutrition

Stefan Jacobson

doi:10.3109/00365521.2011.648954

Abstract

Objective. The effect of preoperative total parenteral nutrition (TPN) on the rate of early (within 30 days) postoperative complications in patients with moderate to severe Crohn's disease (CD) was examined. Material and methods. A series of 15 consecutive patients with CD (mean CD activity index score, 270) given preoperative TPN for 18–90 days (mean, 46 days) and undergoing bowel resection and primary anastomosis was compared with matching controls (105 patients) consecutively selected from all CD patients operated in Stockholm County during a preceding 20-year period without preoperative TPN. Results. During the preoperative TPN, all the patients studied displayed clinical remission of CD as reflected in improvement in their general well-being, relief of abdominal pain, and abatement of fever and diarrhea. There was no significant early postoperative complication in the TPN-treated group, whereas there were 29 patients with early postoperative complications in the control group, which means a significantly higher rate of postoperative complications when preoperative TPN was not provided. During the preoperative TPN, some crucial variables increased such as the body weight, the serum concentrations of albumin and triiodothyronine reflecting improved nutritional state, whereas the serum concentration of haptoglobin and the white cell count decreased reflecting decreased inflammatory activity. Conclusions.This study shows that preoperative TPN for at least 18 days may be recommended to be given to patients with moderate to severe CD until clinical remission is achieved in order to minimize the risk of early postoperative complications.

Highlights

In 1932, Crohn’s disease (CD) was clearly described as an entity by B
Enterocutaneous and perianal fistulas healed and abdominal mass disappeared during the total parenteral nutrition (TPN), there were more or less stenotic intestinal CD changes remaining, which were removed at the following operation
Because of central venous catheter (CVC)-associated thrombosis usually presented as ceased infusion, one patient successively was given five CVC:s during 45 days of preoperative TPN, another patient needed three consecutive CVC:s during 76 days of preoperative TPN, a third needed two CVC:s during 54 days of preoperative TPN, and a Number of patients

Summary

Introduction

In 1932, Crohn’s disease (CD) was clearly described as an entity by B. Since about 70% of all patients with CD come to surgery [3], and of all patients undergoing first resections for CD nearly 50% will require a second operation [4], there has been considerable interest in the outcome of surgical treatment for this condition

Methods

Results

Conclusion