Backgrounds/aims: After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes. Methods: Data were extracted from the Recurrence After Whipple's study, a retrospective multicenter study of PD outcomes. Results: In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was "enteral only," "parenteral only," and "enteral and parenteral" in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m2 (p = 0.03), absence of preoperative biliary stenting (p = 0.009), and serum albumin < 36 g/L (p = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN. Conclusions: A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes.

Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study / Russell, Thomas B.; Labib, Peter L.; Murphy, Paula; Ausania, Fabio; Pando, Elizabeth; Roberts, Keith J.; Kausar, Ambareen; Mavroeidis, Vasileios K.; Marangoni, Gabriele; Thomasset, Sarah C.; Frampton, Adam E.; Lykoudis, Pavlos; Maglione, Manuel; Alhaboob, Nassir; Bari, Hassaan; Smith, Andrew M.; Spalding, Duncan; Srinivasan, Parthi; Davidson, Brian R.; Bhogal, Ricky H.; Croagh, Daniel; Dominguez, Ismael; Thakkar, Rohan; Gomez, Dhanny; Silva, Michael A.; Lapolla, Pierfrancesco; Mingoli, Andrea; Porcu, Alberto; Shah, Nehal S.; Hamady, Zaed Z. R.; Al-Sarrieh, Bilal; Serrablo, Alejandro; RAW Study, Collaborators; Aroori, Somaiah; Perra, Teresa; Porcu, Alberto. - In: ANNALS OF HEPATO-BILIARY-PANCREATIC SURGERY. - ISSN 2508-5778. - 28:1(2024), pp. 70-79. [10.14701/ahbps.23-071]

Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study

Porcu, Alberto
Writing – Review & Editing
;
Perra, Teresa
Membro del Collaboration Group
;
Porcu, Alberto
Membro del Collaboration Group
2024-01-01

Abstract

Backgrounds/aims: After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes. Methods: Data were extracted from the Recurrence After Whipple's study, a retrospective multicenter study of PD outcomes. Results: In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was "enteral only," "parenteral only," and "enteral and parenteral" in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m2 (p = 0.03), absence of preoperative biliary stenting (p = 0.009), and serum albumin < 36 g/L (p = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN. Conclusions: A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes.
2024
Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study / Russell, Thomas B.; Labib, Peter L.; Murphy, Paula; Ausania, Fabio; Pando, Elizabeth; Roberts, Keith J.; Kausar, Ambareen; Mavroeidis, Vasileios K.; Marangoni, Gabriele; Thomasset, Sarah C.; Frampton, Adam E.; Lykoudis, Pavlos; Maglione, Manuel; Alhaboob, Nassir; Bari, Hassaan; Smith, Andrew M.; Spalding, Duncan; Srinivasan, Parthi; Davidson, Brian R.; Bhogal, Ricky H.; Croagh, Daniel; Dominguez, Ismael; Thakkar, Rohan; Gomez, Dhanny; Silva, Michael A.; Lapolla, Pierfrancesco; Mingoli, Andrea; Porcu, Alberto; Shah, Nehal S.; Hamady, Zaed Z. R.; Al-Sarrieh, Bilal; Serrablo, Alejandro; RAW Study, Collaborators; Aroori, Somaiah; Perra, Teresa; Porcu, Alberto. - In: ANNALS OF HEPATO-BILIARY-PANCREATIC SURGERY. - ISSN 2508-5778. - 28:1(2024), pp. 70-79. [10.14701/ahbps.23-071]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11388/324930
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