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Effect of early fasting and total parenteral nutrition support on the healing of incision and nutritional status in patients after sacrectomy - 11/06/18

Doi : 10.1016/j.otsr.2018.02.006 
S. Gao a, , Y. Zheng b, X. Liu c, Z. Tian c, Y. Zhao c
a Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7, Weiwu Road, 450003 Zhengzhou, Henan Province, People's Republic of China 
b Department of radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, 450052 Zhengzhou, Henan Province, People's Republic of China 
c Department of Orthopedics, The Affiliated Tumor Hospital of Zhengzhou University, No. 127, Dongming Road, 450008 Zhengzhou, Henan Province, People's Republic of China 

Corresponding author.

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Abstract

Introduction

Surgical site infection is one of the most common complications for patients after sacrectomy, which often accompanied by poor wound healing, sinus formation and serious metabolic disturbance.

Hypothesis

We tried to avoid the surgical site infection caused by feces during early period after surgery through early fasting and total parenteral nutrition (TPN) support, then compared the clinical results of these patients with other patients that received enteral nutrition (EN) early after sacrectomy.

Methods

Forty-eight patients after sacrectomy (the level of sacrectomy above S2) were randomly divided into two groups: TPN group and EN group. The patients of two groups received different nutrition support from the first day to the seventh day after surgery, then the factors such as nutritional and metabolic status after surgery, incidence of complications as well as the time of incision healing and hospitalization were observed.

Results

The p-value of total serum protein, albumin, serum alanine aminotransferase, total bilirubin at seventh day after sacrectomy between TPN group and EN group is <0.0005. The p-value of hemoglobin at seventh day after sacrectomy between TPN group and EN group is 0.001. The p-value of total serum protein at fourteenth day after sacrectomy between TPN group and EN group is 0.003. The p-value of albumin and total bilirubin at fourteenth day after sacrectomy between TPN group and EN group is 0.001. The p-value of hemoglobin, serum alanine aminotransferase at fourteenth day after sacrectomy between TPN group and EN group is <0.0005. The incidence of gastrointestinal complication and delay of apparition of feces in EN group were lower than that in TPN group (p=0.041, p<0.0005). The incidence of surgical site infection, the time of incision healing and hospitalization in TPN group were lower than that in EN group (p=0.048, p=0.008, p<0.0005).

Conclusions

The method of fasting and supported by TPN during the early period after sacrectomy contribute to the incision healing, meanwhile, it shortens the hospitalization time and abates the incidence of complications in patients after sacrectomy.

Type of study

It is a comparative randomized study.

Level of proof

High-powered prospective randomized trial.

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Keywords : Complications, Sacral tumors, Sacrectomy, Total parenteral nutrition


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Vol 104 - N° 4

P. 539-544 - juin 2018 Retour au numéro
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