Comparative study of parenteral and enteral nutrition support after abdominal surgery in elderly patients with malnutrition diagnosed by GLIM criteria

doi:10.16139/j.1007-9610.2024.06.08

Abstract

Abstract:

Objective To observe the effects of postoperative complications, anal exhaust time, immune function and fatigue index of parenteral and enteral nutrition support after abdominal surgery in elderly patients with malnutrition diagnosed by GLIM criteria. Methods Ninty elderly abdominal surgery patients (more than 70 years old) who diagnosed as malnutrition by GLIM 2-step method were divided into enteral nutrition(EN) group and parenteral nutrition (PN) group randomly. The corresponding immune and fatigue indexes were tested on day 1 and day 7 of postoperation. Postoperative complications, anal exhaust time and mean time of hospitalization were observed and analyzed. Results The incidence of malnutritional risk was 61.0% (122/200) in elderly abdominal surgery patients and malnutrition incidence was 45.0% (90/200). IgA, IgM, IgG, CD3, CD4 and CD4/CD8 on postoperative day 7 increased significantly in EN group than those in PN group (P<0.05). The postoperative complications in EN group significantly lower than that in PN group (P<0.05). Anus exhaust time and hospitalization days of EN group were shorter than that of PN group (P<0.05). Fatigue index on postoperative day 7 of EN group was significantly better than that of PN group (P<0.05). Conclusions The malnutrition diagnosis of elderly patients based on GLIM crteria is a necessary prerequisite for nutritional intervention. Early EN support can reduce postoperative complications and hospitalization days in elderly patients, improve postoperative fatigue syndrome and immune status, and improve the patients with malnutrition recover from surgery.

Key words: Nutritional support, Malnutrition, Elderly abdominal surgery patient, Global leadership initiative on malnutrition(GLIM)

CLC Number:

R656
R459.3

CAI Zhuowei, ZHU Dengfeng, CHEN Minggan, CAI Yiting, CHEN Dawei, GAO Ming. Comparative study of parenteral and enteral nutrition support after abdominal surgery in elderly patients with malnutrition diagnosed by GLIM criteria[J]. Journal of Surgery Concepts & Practice, 2024, 29(06): 503-509.

Figures/Tables 7

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Item	Cases	Cases of nutrition risk	χ² value	P value
Gender			0.014	>0.05
Male	117	72（61.5%）
Female	83	50（60.2%）
Age group			0.120	>0.05
70-79	140	87（62.1%）
80-85	60	35（58.3%）
Total	200	122（61.0%）

Item		Disease of biliary tract (n=12)	Gastrointestinal disease (n=78)	Total (n=90)	χ² value	P value
Phenotypic criteria	Loss of weight	9	60	69(76.7%)	0.021	0.883
Phenotypic criteria	Low BMI	6	41	47(52.2%)	0.027	0.869
The etiology of the standard	Feeding reduction or digestive dysfunction	11	75	86(95.6%)	0.493	0.483
The etiology of the standard	Inflammatory status / disease burden	12	78	90(100%)	/	/

Item	EN group(n=45)	PN group(n=45)	t/χ² value	P value
Age (year)	75.5±6.5	76.8±7.2	-0.899	0.371
Gender (male / female)	21/24	20/25	0.045	0.832
weight (kg)	68.4±7.1	69.3±6.7	-0.618	0.538
Minimally invasive / open surgery	0.371	0.832	0.538	0.796
Malignant / benign disease	10/35	9/36	0.067	0.796
Emergency / elective	32/13	33/12	0.055	0.814

Item		EN group（n=45）	PN group（n=45）	total	χ² value	P value
Anastomotic leakage	Operation on biliary tract	0	1（1.1%）	1	/	/
Anastomotic leakage	Gastrointestinal surgery	2（2.2%）	5（5.5%）	7	/	/
Pulmonary infection	Operation on biliary tract	1（1.1%）	1（1.1%）	2	/	/
Pulmonary infection	Gastrointestinal surgery	2（2.2%）	7（7.7%）	9	/	/
Infection of incisional wound	Operation on biliary tract	0	1（1.1%）	1	/	/
Infection of incisional wound	Gastrointestinal surgery	1（1.1%）	1（1.1%）	2	/	/
Total		6	16		6.016	0.014

Item	EN group (n=45)	PN group (n=45)	t/χ² value	P value
Anus exhaust time	3.18±0.94	3.67±1.19	-2.168	0.033
hospitalization days	12.68±2.1	15.27±2.2	-5.713	<0.001