Impact of preoperative enteral nutritional support on postoperative outcome in patients with Crohn's disease complicated by malnutrition
- 1 June 2021
- journal article
- research article
- Published by Wiley in Colorectal Disease
- Vol. 23 (6), 1451-1462
- https://doi.org/10.1111/codi.15600
Abstract
Aim: Postoperative morbidity is high in patients operated on for Crohn's disease (CD) complicated by malnutrition. This study aimed to evaluate the impact of preoperative enteral nutritional support (PENS) on postoperative outcome in patients with CD complicated by malnutrition included in a prospective nationwide cohort. Method: Malnutrition was defined as body mass index <18 kg/m(2) and/or albuminaemia 10%. Failure of PENS was defined as the requirement for additional preoperative parenteral nutrition to PENS. Univariate analysis of the risk factors for PENS failure was performed. Propensity score matching (PSM) was used to compare the outcomes between 'upfront surgery' and 'PENS' groups. The primary endpoint was the rate of intra-abdominal septic morbidity and/or temporary defunctioning stoma. Results:Among 592 patients included, 149 were selected. In the intention-to-treat population including 20 (13.4%) patients with PENS failure after PSM, 78 'upfront surgery' and 71 'PENS'-matched patients were compared, with no significant difference in the primary endpoint. Perforating CD and preoperative intra-abdominal fistula were associated with 'PENS' failure [37.5 vs 16.1% (P = 0.047) and 41.2% vs 16.2% (P = 0.020), respectively]. After exclusion of these 20 patients, PSM was used to compare 45 'upfront surgery' and 51 'PENS'-matched patients, with a significantly decreased rate of intra-abdominal septic complications and/or temporary defunctioning stoma in the PENS group (19.6 vs 42.2%, P = 0.016). Conclusion:Preoperative enteral nutritional support is associated with a trend but no conclusive evidence of a reduction in intra-abdominal septic complications and/or requirement for defunctioning stoma. Patients with perforating CD complicated with malnutrition are at risk of PENS failure.This publication has 34 references indexed in Scilit:
- Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutritionScandinavian Journal of Gastroenterology, 2012
- Morbidity related to defunctioning ileostomy closure after ileal pouch-anal anastomosis and low colonic anastomosisInternational Journal of Colorectal Disease, 2011
- An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational StudiesMultivariate Behavioral Research, 2011
- Epidemiology and Natural History of Inflammatory Bowel DiseasesGastroenterology, 2011
- An overview of the objectives of and the approaches to propensity score analysesEuropean Heart Journal, 2011
- A Tutorial and Case Study in Propensity Score Analysis: An Application to Estimating the Effect of In-Hospital Smoking Cessation Counseling on MortalityMultivariate Behavioral Research, 2011
- Pre‐operative management is associated with low rate of post‐operative morbidity in penetrating Crohn’s diseaseAlimentary Pharmacology & Therapeutics, 2010
- Impact of Complex Crohn's Disease on the Outcome of Laparoscopic Ileocecal ResectionDiseases of the Colon & Rectum, 2009
- Classification of Surgical ComplicationsAnnals of Surgery, 2004
- Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trialThe Lancet, 2001