Early Parenteral Nutrition reduces nosocomial infection risk after Abdominal Surgery

In a new study conducted by Xuejin Gao and team it was found that early supplementary parenteral nutrition (E-SPN) has been linked to less nosocomial infections in patients following abdominal surgery, and it appears to be a promising treatment for patients having high nutritional risk and low tolerance to enteral nutrition (EN) post major abdominal surgery. The findings of this study were published in the Journal of American Medical Association - Surgery.

The efficacy of the ideal time for commencing supplementary parenteral nutrition (SPN) following major abdominal surgery for patients whose energy objectives cannot be fulfilled by EN alone remains unknown. The goal of this study was to see if late supplemental parenteral nutrition (L-SPN) (day 8 after surgery) or early supplemental parenteral nutrition (E-SPN) (day 3 after surgery) reduced the number of nosocomial infections in the patients who are undergoing major abdominal surgery and are at increased nutritional risk and have low tolerance to EN.

From April 1, 2017, to December 31, 2018, a multicenter randomized clinical study was undertaken in the general surgery departments of 11 tertiary hospitals in China. Participants were those undergoing major abdominal surgery with a high nutritional risk and poor tolerance to EN and a postoperative hospital stay of more than 7 days. The data was analyzed between February 1 and October 31, 2020. This research evaluated random assignment to E-SPN (beginning on day 3 after surgery) or L-SPN (starting on day 8 after surgery).

The findings of this study are as follow:

1. A total of 230 patients were assigned to one of the groups.

2. Before the intervention, 1 patient in the L-SPN group withdrew informed permission.

3. Between days 3 and 7, the E-SPN group received greater mean (SD) energy supply than the L-SPN group.

4. When compared to the L-SPN group, the E-SPN group had considerably fewer nosocomial infections.

5. There were no significant changes in the mean number of noninfectious complications, total adverse events, or rates of any secondary outcomes between the E-SPN and L-SPN groups.

6. There was a significant difference in the mean number of therapeutic antibiotic days between the E-SPN and L-SPN groups.

In conclusion, to lower the prevalence of nosocomial infections following major abdominal surgery, early SPN appears to be a good treatment for patients at increased nutritional risk and with low tolerance to EN.

Reference:

Gao X, Liu Y, Zhang L, et al. Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery: A Randomized Clinical Trial. JAMA Surg. Published online March 16, 2022. doi:10.1001/jamasurg.2022.0269

Keywords: nosocomial infection, surgery, tolerance, antibiotics, infection, supplement, enteral nutrition, abdominal surgery, parenteral, nutrition,                   JAMA,