Abstract

Impact of preoperative enteral nutritional support on postoperative outcome in patients with Crohn's disease complicated by malnutrition. Results of a subgroup analysis of the nationwide cohort registry from the GETAID Chirurgie group

Colorectal Dis. 2021 Feb 23. doi: 10.1111/codi.15600. Online ahead of print.

Solafah Abdalla 1 2, Stéphane Benoist 1, Léon Maggiori 3, Philippe Zerbib 4, Jérémie H Lefevre 5, Quentin Denost 6, Adeline Germain 7, Eddy Cotte 8, Laura Beyer-Berjot 9, Hélène Corte 3, Véronique Desfourneaux 10, Amine Rahili 11, Jean-Pierre Duffas 12, Karine Pautrat 13, Christine Denet 14, Valérie Bridoux 15, Guillaume Meurette 16, Jean-Luc Faucheron 17, Jérôme Loriau 18, Françoise Guillon 19, Eric Vicaut 20, Yves Panis 21, Antoine Brouquet 1 2, GETAID Chirurgie Group

 
     

Author information

  • 1Department of Digestive Surgery and Surgical Oncology, Hôpital Bicêtre, Université Paris Saclay, APHP, 94275, Le Kremlin Bicêtre, France.
  • 2UMR 1195, Institut National de la Santé et de la Recherche Médicale, Université Paris Saclay, Hôpital de Bicêtre, 94275, Le Kremlin Bicêtre, France.
  • 3Department of Digestive Surgery, Hôpital Saint-Louis, APHP, Université Paris VII, 75010, Paris, France.
  • 4Department of Digestive Surgery, CHU Lille, 59000, Lille, France.
  • 5Department of Digestive Surgery, Université Paris Sorbonne, Hôpital Saint Antoine, APHP, 75012, Paris, France.
  • 6Department of Digestive Surgery, CHU Bordeaux, 33000, Bordeaux, France.
  • 7Department of Digestive Surgery, CHRU Nancy, 54000, Nancy, France.
  • 8Department of Digestive Surgery, CHU Lyon-Sud, 69230, Pierre-Bénite, France.
  • 9Department of Digestive Surgery, CHU Marseille-Nord, 13015, Marseille, France.
  • 10Department of Digestive Surgery, CHU Rennes, 35000, Rennes, France.
  • 11Department of Digestive Surgery, CHU Nice, 06200, Nice, France.
  • 12Department of Digestive Surgery, CHU Toulouse-Rangueil, 31059, Toulouse, France.
  • 13Department of Digestive Surgery, Hôpital Lariboisière, APHP, Université Paris VII, 75010, Paris, France.
  • 14Department of Digestive Surgery, Institut Mutualiste Montsouris, 75014, Paris, France.
  • 15Department of Digestive Surgery, CHU Rouen, 76031, Rouen, France.
  • 16Department of Digestive Surgery, CHU Nantes, France.
  • 17Department of Digestive Surgery, CHU Grenoble, 38700, La Tronche, France.
  • 18Department of Digestive Surgery, Hôpital Saint Joseph, 75015, Paris, France.
  • 19Department of Digestive Surgery, CHU Montpellier, 34090, Montpellier, France.
  • 20Unité de recherche clinique, Hôpital Fernand Widal, AP-HP, Université Paris VII, 75010, Paris, France.
  • 21Department of Colorectal Surgery, Hôpital Beaujon, Université Paris VII, APHP, 92118, Clichy, France.

Abstract

Aim: Postoperative morbidity in patients operated for Crohn's disease (CD) complicated by malnutrition is high. This study aimed to evaluate the impact of preoperative enteral nutritional support (PENS) on postoperative outcome in patients with CD complicated by malnutrition included in a prospective nationwide cohort.

Method: Malnutrition was defined as body mass index<18 kg/m2 and/or albuminemia<30g/L and/or weight loss>10%. PENS failure was defined as the requirement of additional preoperative parenteral nutrition to PENS. Univariate analysis of the risk factors of PENS failure was performed. Propensity score matching (PSM) was used to compare the outcomes between "upfront surgery" and "PENS" groups. The primary endpoint was the rate of intraabdominal septic morbidity and/or temporary defunctioning stoma.

Results: Among 592 patients included, 149 were selected. In the intent to treat population including 20 (13.4%) patients with PENS failure, after PSM, 78 "upfront surgery" and 71 "PENS"-matched patients were compared, with no significant difference in the primary endpoint. Perforating CD and preoperative intraabdominal fistula were associated with PENS failure (37.5 vs 16.1%, P=0.047, and 41.2% vs 16.2%, P=0.020 respectively). After exclusion of these 20 patients, PSM was used to compare 45 "upfront surgery" and 51 "PENS"-matched patients, with a significantly decreased rate of intra-abdominal septic complications and/or temporary defunctioning stoma in the PENS group (19.6 vs 42.2%, P=0.016).

Conclusions: PENS is associated with a trend but no conclusive evidence of reduction in intra-abdominal septic complications and/or defunctioning stoma requirement. Patients with perforating CD complicated with malnutrition are at risk of PENS failure.

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