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[Morbidity and mortality from ileal duct and its relationship with post-surgical total parenteral nutrition].

BACKGROUND
The frequency of complications and early death in patients with hyponutrition and total radical cystectomy with ileal duct is high. The role of artificial nutritional support on short-term outcomes is still controversial.


OBJECTIVE
to determine whether total parenteral nutrition reduces the frequency of complications and death when it is administered during the immediate post-surgical period.


DESIGN
cohort study.


SETTING
third-level reference hospital.


SUBJECTS
One hundred and fourteen consecutive patients having radical cystectomy and ileal duct between January of 2000 and June of 2004.


INTERVENTIONS
Eight-one patients received post-surgical total parenteral nutrition for an average of 9.2 days, and 33 controls received 5% dextrose solution + 0.9% saline solution. MAIN RESULTS AND MEASUREMENTS: thirty-six (31.6%) patients had complications and 11 (9.6%) died. The main death-related complications were of surgical origin. After a multiple regression multivariate analysis, and according to risk and nutritional intervention, an important reduction of early death was found in the group with severe hyponutrition (RR = 0.09; 95% CI = 0.02-0.33; p = 0.008). Anastomosis dehiscence in the presence of abdominal sepsis was the most important predictive factor of early death (RR = 5.0; 95% CI = 1.45-17.3; p = 0.007).


CONCLUSIONS
The group with no hyponutrition or with mild hyponutrition does not benefit from post-surgical total parenteral nutrition.