The Role Of Parenteral Nutrition In The Preoperative Optimization Of Patients With Crohn's Disease

Objectives:1.To study the preoperative TPN outcome and compare the outcomes of patients with different outcomes for CD patients with TPN indications.2.To investigate the effect of TPN support and early surgical intervention on postoperative outcomes in patients who are still unable to perform EN after TPN.Methods:This is a single-center,cross-sectional observational study that does not interfere with patients' treatment.In this research,Patients were selected from Department of General Surgery,The Center for Inflammatory Bowel Disease,Jinling Hospital,from 2012.01.01 to 2017.12.31,with crohn's disease requiring surgery.Patients were divided into TPN and non-nutrition support group according to whether they used TPN.According to the outcome of TPN use,patients were divided into transition to EN group and direct surgery group.Collect these demographic data,clinical data,and laboratory test results.SPSS 23.0 software was used for statistical analysis of data.Measured data with normal distribution were expressed as mean ± SD.Mean skewed distribution data was expressed as median(interquartile range).Count data or grade data was used.Contingency table representation with frequency and frequency.Continuous variables were selected t test or rank sum test for comparison betwTEN groups;categorical variable groups were compared using Chi-square test or Fisher's exact test.The difference was statistically significant at P<0.05.Results:1.128 patients enrolled.Among them,19 were non-nutrition support group and 109 were TPN group.In the TPN group,55 patients were switched to TEN or PEN,29 of whom were converted to TEN,and 26 were PEN patients;54 patients received TPN support before surgery.2.Compared with patients who did not undergo TPN,the preoperative TPN support patients had a significant reduction in the ostomy rate(p=0.037)and postoperative complications were significantly lower(p<0.001),suggesting a positive effect of TPN on surgery.Logistic regression analysis of ostomy risk factors indicated that the basic conditions of age,preoperative CRP,Plt,WBC,Alb,and BMI were all influencing factors of ostomy.Preoperative use of TPN was a protective factor for ostomy(OR=6.495,p=0.038).3.Compare the postoperative status of each subgroup.The stoma rate in patients who transitioned to EN was significantly lower than in those who underwent direct surgery(p=0.005)and postoperative complications were also significantly reduced(p<0.001);patients who underwent direct surgery compared with those who did not receive TPN support,although postoperatively The complications were significantly lower(p=0.01),but the stoma rate did not change significantly(p=0.325).Conclusions:1.The use of TPN before surgery can effectively reduce the ostomy rate and reduce postoperative complications.It is of positive significance to the patient.2.Patients with transition from TPN to TEN or PEN can significantly reduce stoma rate and postoperative complications.Tips for better surgical outcomes.This group of patients is the patient who has benefited most from TPN.3.For patients who are still unable to transition to TEN or PEN within 2 weeks of TPN,continuing TPN support treatment will no longer reduce the stoma rate.Considering the complications and costs of TPN,it is recommended that early surgical treatment be performed to avoid long-term TPN.