The impact of post-operative enteral nutrition on duodenal injury outcomes: A post hoc analysis of an EAST multicenter trial.

Autor:	Choron RL, Rallo M, Piplani C, Youssef S, Teichman AL, Bargoud CG, Sciarretta JD, Smith RN, Hanos DS, Afif IN, Beard JH, Dhillon NK, Zhang A, Ghneim M, Devasahayam RJ, Gunter OL, Smith AA, Sun BL, Cao C, Reynolds JK, Hilt LA, Holena D, Chang G, Jonikas M, Echeverria K, Fung N, Anderson A, Dumas RP, Fitzgerald CA, Levin J, Trankiem C, Yoon JJ, Blank J, Hazelton J, McLaughlin CJ, Al-Aref R, Kirsch JM, Howard DS, Scantling DR, Dellonte K, Vella M, Hopkins B, Shell C, Udekwu PO, Wong EG, Joseph BA, Lieberman H, Ramsey W, Stewart C, Alvarez C, Berne JD, Nahmias J, Puente I, Patton JP, Rakitin I, Perea LL, Pulido OR, Ahmed H, Keating J, Kodadek L, Wade J, Henry R, Schreiber M, Benjamin A, Khan A, Mann LK, Mentzer C, Mousafeiris V, Mulita F, Reid-Gruner S, Sais E, Foote C, Palacio-Lascano C, Argandykov D, Kaafarani H, Bover Manderski M, Narayan M, Seamon MJ
Jazyk:	angličtina
Zdroj:	The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2024 May 15. Date of Electronic Publication: 2024 May 15.
DOI:	10.1097/TA.0000000000004303
Abstrakt:	Background: Leak following surgical repair of traumatic duodenal injuries results in prolonged hospitalization and oftentimes nil per os(NPO) treatment. Parenteral nutrition(PN) has known morbidity; however, duodenal leak(DL) patients often have complex injuries and hospital courses resulting in barriers to enteral nutrition(EN). We hypothesized EN alone would be associated with 1)shorter duration until leak closure and 2)less infectious complications and shorter hospital length of stay(HLOS) compared to PN. Methods: This was a post-hoc analysis of a retrospective, multicenter study from 35 Level-1 trauma centers, including patients >14 years-old who underwent surgery for duodenal injuries(1/2010-12/2020) and endured post-operative DL. The study compared nutrition strategies: EN vs PN vs EN + PN using Chi-Square and Kruskal-Wallis tests; if significance was found pairwise comparison or Dunn's test were performed. Results: There were 113 patients with DL: 43 EN, 22 PN, and 48 EN + PN. Patients were young(median age 28 years-old) males(83.2%) with penetrating injuries(81.4%). There was no difference in injury severity or critical illness among the groups, however there were more pancreatic injuries among PN groups. EN patients had less days NPO compared to both PN groups(12 days[IQR23] vs 40[54] vs 33[32],p = <0.001). Time until leak closure was less in EN patients when comparing the three groups(7 days[IQR14.5] vs 15[20.5] vs 25.5[55.8],p = 0.008). EN patients had less intra-abdominal abscesses, bacteremia, and days with drains than the PN groups(all p < 0.05). HLOS was shorter among EN patients vs both PN groups(27 days[24] vs 44[62] vs 45[31],p = 0.001). When controlling for predictors of leak, regression analysis demonstrated EN was associated with shorter HLOS(β -24.9, 95%CI -39.0 to -10.7,p < 0.001). Conclusion: EN was associated with a shorter duration until leak closure, less infectious complications, and shorter length of stay. Contrary to some conventional thought, PN was not associated with decreased time until leak closure. We therefore suggest EN should be the preferred choice of nutrition in patients with duodenal leaks whenever feasible. Level of Evidence: IV. Competing Interests: Conflict of Interest: All JTACS disclosure forms have been supplied and are provided as supplemental digital content (http://links.lww.com/TA/D807). (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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