Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery
What this study found
Early SPN with EN reduced nosocomial infections compared with late SPN: 8.7% (n=10) vs 18.4% (n=21); difference 9.7% (95% CI 0.9%–18.5%), P=0.04. Fewer major infectious complications and shorter therapeutic antibiotic days with E-SPN (6.0 vs 7.0 days, P=0.01). During days 3–7, daily energy intake was higher with E-SPN (26.5 ± 7.4 vs 15.1 ± 4.8 kcal/kg/day, P<0.001) and protein intake higher (1.02 ± 0.28 vs 0.48 ± 0.17 g/kg/day, P<0.001). No significant differences in noninfectious complications or total adverse events. Authors conclude that initiating early SPN alongside EN is a favorable…
- Study & population
- Multicenter, open-label randomized clinical trial at 11 tertiary hospitals in China; 230 adults undergoing major abdominal surgery with high nutritional risk and poor tolerance to enteral nutrition (EN supplying <30% of energy targets by postoperative day 2); randomized 1:1 to E-SPN or L-SPN; mean age 60.1 ± 11.2 years; 61.1% male; all participants Han…
- Intervention
- Early supplemental parenteral nutrition (E-SPN): start on postoperative day 3; intravenous PN with energy density 0.88 kcal/mL; composition 15% protein, 40% lipids, 45% carbohydrates; route: peripheral or central vein; energy target = 100% of energy requirement; daily energy target = 30 kcal/kg ideal body weight for…
- Key limitation
- Indirect calorimetry to measure resting energy expenditure not used; open-label design with unblinded patients and care providers (though outcome assessors were blinded); limited generalizability beyond the Han Chinese population.
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Open PDFOriginal abstract
Key Points Question When should supplemental parenteral nutrition (SPN) after major abdominal surgery be considered for patients in whom energy targets cannot be met by enteral nutrition alone? Findings This multicenter randomized clinical trial compared the effect of early supplemental parenteral nutrition (E-SPN) and late supplemental parenteral nutrition (L-SPN) in 230 patients with high nutritional risk and poor tolerance to enteral nutrition after major abdominal surgery. Results showed that E-SPN in combination with enteral nutrition was associated with a reduced incidence of nosocomial infection compared with L-SPN. Meaning These findings provide evidence that E-SPN in combination with enteral nutrition after major abdominal surgery is preferable to L-SPN to reduce nosocomial infections.