K. A. Quinton1, C. J. Guy-Frank1, B. Weiner2, J. M. Klugh1, S. Syed1, H. R. Kregel1, J. A. Harvin1, L. S. Kao1 1University Of Texas Health Science Center At Houston, Department Of Surgery, Houston, TX, USA 2Memorial Hermann Hospital, Houston, TX, USA
Introduction:
Trauma laparotomy patients are at high risk for postoperative infectious complications, which can be worsened by inadequate nutritional intake. We hypothesized that trauma laparotomy patients who require bowel resection versus those that do not have greater nutritional deficiencies and increased postoperative infectious complications.
Methods:
Adult trauma laparotomy patients from 2019 were retrospectively reviewed from a prospectively maintained database. Patients <18 years old or who died or were discharged <7 days postoperatively were excluded. A licensed dietitian reviewed patients’ diets (Per Os (PO), tube feeds (TF), total parenteral nutrition (TPN), or combinations). For patients requiring nutrition support (TF/TPN) >7 days, protein and kcal deficits were calculated at 7 and 14 days. Energy targets were calculated as 25-35kcal/kg of actual or ideal body weight (BMI dependent) based on injury pattern and clinician discretion. Protein requirements were determined as 1.2-2g/kg of actual or ideal body weight (BMI dependent). For nutrition deficit comparison, percent of total length of stay with an NPO or clear liquid diet was determined for patients who did not require TF/TPN. Univariate analyses were performed using Kruskal-Wallis Test and Chi Square.
Results:
Of the 113 patients, 48 required a small and/or large bowel resection (BRx). There were no significant differences in demographics, preoperative vitals/labs, or injury severity score between the groups besides their abdominal abbreviated injury scale (4 [3.5,4] vs. 3 [2,4] p<.001). The BRx group had higher rates of TPN use (33 vs 9%, p=.001). Of the patients who never received TF/TPN nutritional support (N=49, 43%), those with BRx spent a greater percent of their days admitted on an NPO/clear liquid diet (50% [26%-86%] vs 7% [0%-21%], p<.001). Among patients who required TF/TPN nutritional support for more than 7 days (43%), those who underwent BRx (53%) had greater caloric and protein deficits at both 7 and 14 days (Table). The BRx group had higher rates of ileus, hernias, acute renal failure, dehiscence, deep and organ-space surgical site infections; however, they had lower rate of decubitus ulcers. There were no differences in hospital length of stay or mortality.
Conclusion:
Trauma laparotomy patients undergoing bowel resection were more likely to require TPN during their hospitalization, to have significant caloric deficits at 7 and 14 days postoperatively, and to suffer from abdominal complications. Future interventions should focus on minimizing nutritional deficits in this patient population.
