P0964Exclusive total parenteral nutrition prior to Crohn’s Disease surgery reduces major postoperative complications

Abstract Background Optimization of nutritional status is considered essential prior to bowel resection in Crohn’s disease (CD). However, data regarding the effectiveness of different nutritional interventions on postoperative morbidity remain inconsistent, and the benefit of preoperative nutritional optimization in patients without severe malnutrition is not well established. We aimed to prospectively evaluate the impact of exclusive total parenteral nutrition (TPN) in post operative morbidity. Methods We conducted a prospective cohort study including adult patients electively scheduled for CD-related bowel resection who agreed to undergo preoperative exclusive TPN. Patients who did not complete ≥4 weeks of exclusive TPN were excluded. The primary endpoint was a composite of major postoperative complications: anastomotic leak, intra-abdominal abscess, or need for re-operation. Outcomes were compared with a retrospective cohort of CD patients who underwent similar surgeries without preoperative nutritional intervention. Results Thirty-seven patients were included in the TPN group and 33 in the control group. In the TPN group, mean age was 33.1 ± 14.2 years; 26 (69.7%) were male; mean disease duration was 12.2 ± 10.9 years; Six (16.2%) had prior CD-related surgery; Fifteen (40.5%) were active smokers; and 34 (91.9%) had isolated small-bowel disease. Nineteen (51.4%) had fibro-stenotic disease, and the remainder had penetrating disease. The mean duration of TPN was 82.9 ± 37.6 days, and 15 (40.5%) fully adhered to exclusive TPN. Clinical disease activity improved substantially: 25 (78.1%) had moderate–severe HBI (7) at baseline vs. 4 (17.4%) preoperatively. Albumin increased from 3.3 ± 0.7 to 3.8 ± 0.6 g/dL, and CRP decreased from 9.1 ± 5.6 to 2.2 ± 3.2 mg/dL. Major postoperative complications occurred in 1/37 (2.7%) in the TPN group vs. 7/33 (21.2%) in controls (p = 0.04). Two patients (5.6%) required a stoma, comparable to the rate in the regular preparation group 2/33 (6.1%). In a multivariable logistic regression model excluding ASA score and adjusting for age at surgery, smoking status, and previous ileocolonic resection, exclusive TPN was independently associated with a significantly lower odds of composite post-operative complications (adjusted OR 0.05, 95% CI 0.01–0.48, Pvalue0.01). Conclusion A structured preoperative prehabilitation protocol incorporating exclusive TPN was associated with significant improvements in nutritional and inflammatory markers and a markedly lower rate of major postoperative complications. These findings support the integration of exclusive TPN into preoperative optimization strategies for Crohn’s disease surgery. Conflict of interest: Dr. Mahajna, Hussein: No conflict of interest Darawsha, Abd Elkarem: No conflict of interest Abu-Hatoum, Ossama: No conflict of interest Hershko, Dan: No conflict of interest N.Gralnek, Ariel: No conflict of interest Zittan, Eran: No conflict of interest