Document Detail

Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group.
MedLine Citation:
PMID:  1906987     Owner:  NLM     Status:  MEDLINE    
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.
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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    
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MeSH Terms
Middle Aged
Monitoring, Physiologic
Nutritional Status
Parenteral Nutrition, Total* / adverse effects
Postoperative Care*
Postoperative Complications / prevention & control
Preoperative Care*
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 ]

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