| Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. | |
| | |
MedLine Citation:
|
PMID: 1906987 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: We undertook this study to test the hypothesis that perioperative total parenteral nutrition (TPN) decreases the incidence of serious complications after major abdominal or thoracic surgical procedures in malnourished patients. METHODS: We studied 395 malnourished patients (99 percent of them male) who required laparotomy or noncardiac thoracotomy. They were randomly assigned to receive either TPN for 7 to 15 days before surgery and 3 days afterward (the TPN group) or no perioperative TPN (the control group). The patients were monitored for complications for 90 days after surgery. RESULTS: The rates of major complications during the first 30 days after surgery in the two groups were similar (TPN group, 25.5 percent; control group, 24.6 percent), as were the overall 90-day mortality rates (13.4 percent and 10.5 percent, respectively). There were more infectious complications in the TPN group than in the controls (14.1 vs. 6.4 percent; P = 0.01; relative risk, 2.20; 95 percent confidence interval, 1.19 to 4.05), but slightly more noninfectious complications in the control group (16.7 vs. 22.2 percent; P = 0.20; relative risk, 0.75; 95 percent confidence interval, 0.50 to 1.13). The increased rate of infections was confined to patients categorized as either borderline or mildly malnourished, according to Subjective Global Assessment or an objective nutritional assessment, and these patients had no demonstrable benefit from TPN. In contrast, severely malnourished patients who received TPN had fewer noninfectious complications than controls (5 vs. 43 percent; P = 0.03; relative risk, 0.12; 95 percent confidence interval, 0.02 to 0.91), with no concomitant increase in infectious complications. CONCLUSIONS: The use of preoperative TPN should be limited to patients who are severely malnourished unless there are other specific indications. |
| | |
Authors:
|
- |
Related Documents
:
|
12432317 - The 2002 clinical research award. an evaluation of the safety of early vs delayed enter... 8402497 - Parenteral nutrition associated with increased infection rate in children with cancer. 20044147 - Otitis media with effusion: recurrence after tympanostomy tube extrusion. 20877957 - Parenteral nutrition versus enteral nutrition in severe acute pancreatitis. 12432317 - The 2002 clinical research award. an evaluation of the safety of early vs delayed enter... 20889937 - The association between lower extremity continuous peripheral nerve blocks and patient ... |
Publication Detail:
|
Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
|
Title: The New England journal of medicine Volume: 325 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 1991 Aug |
Date Detail:
|
Created Date: 1991-08-26 Completed Date: 1991-08-26 Revised Date: 2010-03-24 |
Medline Journal Info:
|
Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 525-32 Citation Subset: AIM; IM |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Female Humans Laparotomy Male Middle Aged Monitoring, Physiologic Nutritional Status Parenteral Nutrition, Total* / adverse effects Postoperative Care* Postoperative Complications / prevention & control Preoperative Care* Thoracotomy |
| Comments/Corrections | |
Comment In:
|
N Engl J Med. 1992 Jan 23;326(4):273-4
[PMID:
1550616
]
N Engl J Med. 1992 Jan 23;326(4):273; author reply 274 [PMID: 1727984 ] N Engl J Med. 1991 Aug 22;325(8):573-5 [PMID: 1830369 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Study of the dependence of gene expression of plague pathogen plasmid 65MD on the host bacterium gen...
Next Document: Formation of beta-amyloid protein deposits in brains of transgenic mice.