Short-term preoperative parenteral nutrition benefits malnourished patients undergoing major gastrointestinal surgery

Rajesh Pendlimari, Nagesh N. Swamygowda, Shreedevi K. Nagadas, Kaushik Subramanian


Background: Pre-operative nutritional support is of paramount in malnourished patients undergoing major gastrointestinal (GI) surgery. We aimed to investigate the outcomes of short term pre-operative parenteral nutrition in nutritionally depleted patients undergoing major GI surgeries.

Methods: A retrospective study from tertiary care centre in South India, where nutritionally at risk patients undergoing major GI surgeries from 2016-2018 were identified and reviewed. Two groups –who received total or peripheral parenteral nutrition (TPN and PPN) and only enteral nutrition..

Results: Of 80 patients who were nutritionally depleted underwent major GI surgery, 38 patients received pre-operative parenteral nutrition (PN) support for mean 11 days. Patients who received pre-op PN had similar outcomes (overall complication rate n=26, 68.4% vs n=32, 76.2% p=0.43), when compared to patients who received pre-op enteral nutrition conditioning. Though a small group of patients received peripheral PN supplementation, there was no difference in overall complication rate, when compared with TPN group (n=14, 58.3% vs n=12, 85.7%, p=0.08).

Conclusions: Parenteral nutrition either total or supplemental is a useful adjunct pre-operatively for poorly nourished patients and should be utilized to build nutrition prior to major GI surgery. Pre-operative peripheral parenteral nutrition as supplement seems to be beneficial in patients undergoing GI surgery, pending large studies.


Enteral nutrition, Gastrointestinal surgery, Malnutrition, Parenteral nutrition

Full Text:



Klein S. A primer of nutritional support for gastro-enterologists. Gastroenterol. 2002;122(6):1677-87.

Nakamura K. Influence of preoperative nutritional state on inflammatory response after surgery. Nutrition. 1999;15(11-12):834-41.

Norman K. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27(1):5-15.

Macfie J. Oral dietary supplements in pre- and postoperative surgical patients: a prospective and randomized clinical trial. Nutrition. 2000;16(9):723-8.

Varadharajan KS, Thomas T, Kurpad AV. Poverty and the state of nutrition in India. Asia Pac J Clin Nutr. 2013;22(3):326-39.

Braga M. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr. 2009;28(4):378-86.

Jie B. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition. 2010;26(11-12):1088-93.

Kondrup J. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415-21.

Studley HO. Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer 1936. Nutr Hosp. 2001;16(4):141-3.

Torosian MH. Perioperative nutrition support for patients undergoing gastrointestinal surgery: critical analysis and recommendations. World J Surg. 1999;23(6):565-9.

Detsky AS. Perioperative parenteral nutrition: a meta-analysis. Ann Intern Med. 1987;107(2):195-203.

Klek S. Perioperative nutrition in malnourished surgical cancer patients - a prospective, randomized, controlled clinical trial. Clin Nutr. 2011;30(6):708-13.

Ward N. Nutrition support to patients undergoing gastrointestinal surgery. Nutr J. 2003;2:18.

Williams JD, Wischmeyer PE. Assessment of perioperative nutrition practices and attitudes-A national survey of colorectal and GI surgical oncology programs. Am J Surg. 2017;213(6):1010-8.

Braga M. Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. Crit Care Med. 2001;29(2):242-8.

Casaer MP. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506-17.

Heidegger CP. Supplemental parenteral nutrition in critically ill patients--authors' reply. Lancet. 2013;381(9879):1716-7.

Huang D. Early enteral nutrition in combination with parenteral nutrition in elderly patients after surgery due to gastrointestinal cancer. Int J Clin Exp Med, 2015;8(8):13937-45.

Jiang H. Efficacy of hypocaloric parenteral nutrition for surgical patients: a systematic review and meta-analysis. Clin Nutr. 2011;30(6):730-7.