What question did this study set out to answer?

To assess the effectiveness and safety of perioperative total parenteral nutrition in patients undergoing major surgery.

August 1, 1987Annals of Internal Medicine

Perioperative Parenteral Nutrition: A Meta-Analysis

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Why the study?

Does perioperative total parenteral nutrition reduce complications and fatalities in patients having major surgery?

Population

Patients having major surgery

Comparison

Perioperative total parenteral nutrition vs Control (not explicitly detailed in abstract)

Design

Meta-analysis, 11 trials were randomized or quasi-randomized

Authors

ADAllan S. DetskyMount Sinai Hospital

Discussion

Member takes

Implication

Does not support routine perioperative total parenteral nutrition in unselected patients; leaves open possible benefit in malnourished high-risk subgroups.

Key Points

To assess the effectiveness and safety of perioperative total parenteral nutrition in patients undergoing major surgery.
Conducted a systematic meta-analysis of 18 controlled trials published through August 1986.
Extracted and pooled clinical outcomes across 11 randomized or quasi-randomized trials evaluating major postoperative complications, mortality, and iatrogenic adverse events.
Pooled analyses from 11 randomized or quasi-randomized trials showed non-significant trends toward reduced major surgical complications (p = 0.21) and fatalities (p = 0.21).
Iatrogenic complications, specifically pneumothorax and septicemia, occurred at a pooled rate of 0.067 (6.7%).
Methodological limitations and the failure to exclude non-malnourished patients indicate that routine administration is unjustified, though high-risk subgroups may still benefit.

Structured PICO

Does perioperative total parenteral nutrition reduce complications and fatalities in patients having major surgery?

Population

Patients having major surgery (pooled from 18 controlled trials, including 11 randomized or quasi-randomized trials)

Intervention

Perioperative total parenteral nutrition

Comparator

Control (not explicitly detailed in abstract)

Outcome

Complications from major surgery and fatalitieshard clinical

Routine use of perioperative total parenteral nutrition in unselected patients undergoing major surgery is not justified due to lack of significant benefit and risk of iatrogenic complications.

Limitations

poor quality of the trials' methodologies
failure to exclude patients who were not malnourished from the trials

Cite This Study

Allan S. Detsky (1987) studied this question.

synapsesocial.com/papers/6a838825fa1a6ada806fff09 https://doi.org/10.7326/0003-4819-107-2-195

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Implication

Does not support routine perioperative total parenteral nutrition in unselected patients; leaves open possible benefit in malnourished high-risk subgroups.

Perioperative Parenteral Nutrition: A Meta-Analysis

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Perioperative Parenteral Nutrition: A Meta-Analysis

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider