Outpatient preoperative parenteral nutrition in malnourished surgical patients: A feasibility study (the OPPORTUNITY study)

Preoperative parenteral nutrition (PN) improves outcomes in malnourished surgical patients. Traditionally, this requires hospital admission, increasing length of stay and costs-challenges worsened by limited hospital bed availability. Outpatient PN may offer a feasible alternative. This study evaluates the feasibility of administering preoperative PN in an outpatient setting. Malnourished patients scheduled for major surgery, identified using subjective global assessment, received outpatient PN for a median of 5 days (range: 5-8) at an infusion clinic. A multichamber, ready-to-use PN solution was infused via a peripherally inserted central catheter (PICC) over 4-6 h, delivering 1 L volume, 75.9 g protein, and 950 kcal daily. Feasibility and nutrition outcomes were assessed, along with safety metrics including refeeding syndrome, hyperglycemia, volume overload, and catheter-related complications. Eight patients (four males, four females) participated, with pancreatic cancer being the most common diagnosis (n = 3). All patients completed 100% of planned PN infusions. Median scores reported by patients and nurses for acceptability, appropriateness, and feasibility were consistently high (patients (n = 7): acceptability 4.9/5, appropriateness 4.6/5, feasibility 4.9/5; nurses (n = 3): acceptability 4.3/5, appropriateness 5.0/5, feasibility 4.0/5). Nutritional intake improved with median energy increased from 18.3 to 36.0 kcal/kg/day, and protein from 0.90 to 1.5 g/kg/day. No complications were reported. Outpatient preoperative PN using multichamber, ready-to-use PN was feasible. This novel approach has the potential to reduce the need for preoperative hospital admission for PN infusion in malnourished surgical patients. Future studies involving larger populations are needed to evaluate the efficacy of outpatient PN.