ESPEN 2012 - Late breaking abstract submission
Topic: Late Breaking Abstract
Abs n°:ESPEN12-1906
Abs Title: FEEDING JEJUNOSTOMY IN COMPLICATED AND EMERGENCY UPPER GASTROINTESTINAL SURGERY
P. Tonchev 1,*S. Iliev 1V. Radev 2D. Stoikov 1G. Georgieva 3L. Kovachev 1S. Ohri 4R. Komsa-Penkova 3
1Surgery, 2ICU, 3Biochemistry, 4Cardiology, Medical University Pleven, Pleven, Bulgaria
Rationale: Indications and route of enteral nutritional support are not very clear in emergency operations or reoperations following major upper GI surgery.Purpose of this study is to compare length of hospital and ICU stay and mortality in such patients receiving parenteral (PN) versus combined enteral + parenteral nutrition (EN+PN).
Methods: The study was performed at University Hospital from 2008-2011.One hundred and one patients included in the study were divided in two groups: (PN) 68 patients received PN and (PN+EN) 33 patients received combined PN +EN via nutritional jejunostomy .
Nutritional risk was assessed with ESPEN NRS 2002
Operative risk was assessed via operative part of POSSUM scale.
New index combining NRS 2002 with operative POSSUM scale as a predictor of surgical complications and death was investigated.
Energy goals were set to 25kcal/kg/day. Caloric and protein intake were calculated. “Energy deficit“ was calculated in 3, 6, 9 day.
Mortality rate, length of ICU and hospital stay, severity of operation measured with POSSUM operative scale, energy provided, energy deficit at 3,6,9 day, complications of nutritional support were compared in both groups by Student T test, Fisher exact test, Chi squared, Kaplan Maier survival plots, ROC curves etc.
Results: Mortality rate was 38% (PN) versus 18% (PN+EN) (p=0.067). In patients accumulated more than 9000 kcal deficit on 9 day mortality rate was 44% (PN) versus 8% (PN+EN) ( p<0.05). Patients with pneumonia, sepsis, peritonitis were with better survival in PN+EN group. The survival rate after 20 day of treatment was higher in ON+ EN group (p<0.05).
Conclusion: Enteral nutrition improves survival in the patients with complications of major surgery of upper GI tract, It reduces length of ICU stay. This study demonstrates that in case of inadequate nutritional intake EN possess a protective function.
Disclosure of Interest: None Declared
Keywords: enteral nutritionjejunostomy