Michael B Goldberg, MD, Kevin D Helling, MD, Kamran Samakar, Malcom K Robinson, MD, Eric Sheu, MD, PhD, Ashley Vernon, MD, Scott Shikora, MD, Tavakkoli Ali, MD. Brigham and Women’s Hospital
Introduction: Patients uncommonly require total parenteral nutrition (TPN) after bariatric surgery due to postoperative complications. We aim to describe this unique cohort of patients and compare them based on indication necessitating the initiation of TPN.
Methods and Procedures: We retrospectively reviewed institutional data from 2008-2014 identifying patients who required TPN after both primary and revisional bariatric operations; these included roux-en-y gastric bypass, sleeve gastrectomy, and gastric band placement. Data was collected on patient demographics, operative details, indication for TPN and its duration of use, laboratory values, morbidity, and mortality.
Results: Of the 62 patients identified, 55 were female. Mean age at operation was 47 and mean preoperative BMI 40.4. Operations included 46 roux-en-y gastric bypasses (4 open), 7 sleeve gastrectomies, and 4 gastric bands. 68% (42) were revisional operations. Patients were divided into two groups based on indication for TPN use—infectious (including leak, perforation and abscess) and noninfectious failure to thrive (ulcer disease, obstruction, stricture, and other food intolerance). Mean length of TPN use was 44.5 days (range 6-600) in the infectious group and 63 days (range 3-180) in the noninfectious group (p=0.2). BMI before initiating TPN was significantly lower in the noninfectious group, mean 26.7 vs. 40.4 (p=0.0029). When analyzing nutritional studies in these patients, albumin and prealbumin were significantly lower in the infectious group upon initiation of TPN; prealbumin 10.7 vs. 12.5 (p=0.036) and albumin 3.0 vs. 3.3 (p=0.004). When TPN was discontinued, the infectious group continued to have lower nutritional laboratory values; prealbumin 12.8 vs. 15.5 (p=0.039) and albumin 2.8 vs. 3.5 (p=0.0003).Total hospital length of stay (LOS) and ICU LOS were significantly longer in the infectious group on index hospitalization–total LOS 18.5 vs. 12 days (p=0.049), ICU LOS 6.5 vs. 1.5 days (p=0.02). Mortality was not significantly different when comparing the two groups (p=0.62).
Conclusions: Although TPN is rarely needed after bariatric surgery, it is most commonly initiated because of either infectious complications or noninfectious failure to thrive. Patients requiring TPN for infectious indications including leak, perforation, and abscess tend to have more severe malnutrition (despite a higher BMI) and more prolonged hospital stays than those with noninfectious failure to thrive.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80734
Program Number: P565
Presentation Session: Poster (Non CME)
Presentation Type: Poster
