Impact of early enteral and parenteral nutrition on postoperative outcome after abdominal surgery

Abstract

Introduction Nutritional support is a vital therapy of most surgical patients. Early initiation via the enteral route has a significant effect on postoperative recovery. The prognostic role of C-reactive protein (CRP) and albumin can be explained by their abilities to reflect inflammation in the acute phase in critical settings and assess the nutritional status of critically ill patients, respectively. This indicates the prognostic value of the CRP/albumin ratio in postoperative patients admitted to the ICU. Aim To determine the effect of early enteral versus parenteral nutrition on ICU outcome in postoperative abdominal surgical patients and the value of CRP/albumin ratio as an inflammatory marker for both groups. Patients and methods A prospective cohort nonrandomized study included 80 consecutive postoperative major abdominal surgical patients at the Critical Care Department, Cairo University, over 1-year duration. Forty (50%) patients received enteral nutrition 6 h after surgical procedures and 40 (50%) patients received parenteral nutrition 6 h after surgical procedures. Nutritional status and inflammatory markers were screened. All patients were followed up during the ICU stay and up to 3 months. Sepsis-related organ-failure assessment (SOFA) scoring was done every 48 h. Results The study included 57 (71.3%) males with mean age 48.5±18.4 years. Esophagogastrectomy was done in 29 (36.25%) patients, repair of intestinal obstruction in 26 (32.5%) patients, and pancreaticoduodenectomy in 25 (31.25%) patients. Mean ICU stay was 5.16±2.56 days. A statistically significant improvement in serum protein and albumin levels was found at postoperative day (POD)3 and POD5 in comparison with POD1 in the enteral group (P=0.001). There was a statistically significant improvement in serum calcium levels in the enteral group (P=0.001) at POD7. There was a significant decrease in the white-blood cell count at POD7 in comparison with POD1 in both enteral and parenteral groups (P=0.017, 0.041), respectively. There was a significant decrease in CRP levels at POD3, POD5, and POD7 in comparison with POD1 in both enteral and parenteral groups (P<0.001). There was a highly statistically significant decrease in CRP/albumin ratio at days 3, 5, and 7 postoperatively in both enteral and parenteral groups (P<0.001). There was a strong positive significant correlation between CRP/albumin ratio and SOFA score at POD3 in the whole study group (r=0.728, P>0.001). Conclusion Starting nutrition in early postoperative abdominal surgeries either enteral or parenteral had a significant decrease in the parameters of infection. Early enteral nutrition in postoperative abdominal surgeries had significantly improved nutritional status, ICU survival, and decreased in-hospital mortality. There was a strong positive correlation between CRP/albumin ratio and SOFA score in postoperative abdominal surgery patients who started early nutrition.