Early Enteral Feeding, Compared With Parenteral, Reduces Postoperative Septic Complications The Results of a Meta-Analysis

Abstract

This two-part meta-analysis combined data from eight prospective randomized trials designed to compare the nutritional efficacy of early enteral (TEN) and parenteral (TPN) nutrition in high-risk surgical patients. The combined data gave sufficient patient numbers (TEN, n = 118; TPN, n = 112) to adequately address whether route of substrate delivery affected septic complication incidence. Phase I (dropouts excluded) meta-analysis confirmed data homogeneity across study sites, that TEN and TPN groups were comparable, and that significantly fewer TEN patients experienced septic complications (TEN, 18%; TPN, 35%; p = 0.01). Phase II meta-analysis, an intent-to-treat analysis (dropouts included), confirmed that fewer TEN patients developed septic complications. Further breakdown by patient type showed that all trauma and blunt trauma subgroups had the most significant reduction in septic complications when fed enterally. In conclusion, this meta-analysis attests to the feasibility of early postoperative TEN in high-risk surgical patients and that these patients have reduced septic morbidity rates compared with those administered TPN.

Parenteral Nutrition Induces Organ Specific Alterations in Polymeric Immunoglobulin Receptor Levels

“…In studies of severely injured trauma patients, individuals randomized to enteral feeding sustained significantly fewer pneumonias and intraabdominal abscesses than an injured group fed parenterally [15,[20][21][22]. Experimentally, our work and that of others show that route and type of nutrition influence established mucosal immunologic defenses [13,16], intraperitoneal cytokine and immunologic responses [18], and systemic inflammatory responses to injury [6][7][8].…”

“…Parenteral nutrition (PN) increases infectious morbidity due to pneumonia and intra-abdominal abscesses in severely injured patients compared to enteral feeding [15,[20][21][22]. Increasing evidence suggests that a PN-induced mucosal immune deficiency is at least partly responsible for this difference in clinical outcome.…”

Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation: a prospective randomized study

“…14 The patients in the present study received enteral nutrition, which could reduce the rate of infection from 29% to 14%. 25,26 This is probably why the rate of infection in this study was lower than previous reports with symbiotic therapy. In addition, the rate of acute cellular rejection (ACR) was not changed by symbiotic therapy.…”

The Effects of Early Enteral Nutrition Products on the Healing of Colo-Colonic Anastomosis

“…Complications such as intra-abdominal abscesses and pneumonia are more frequent in patients fed with total parenteral nutrition (TPN) compared to patients who receive enteral nutrition. These complications are more common in patients in intensive care units and in patients with serious traumas [17][18][19]. T and/or B lymphocytes in the intestinal mucosa are reduced in patients receiving TPN [20], and intestinal and respiratory IgA levels decrease [21].…”