Prospective randomization of parenteral hyperalimentation for long fusions with spinal deformity - Its effect on complications and recovery from postoperative malnutrition

Study Design. A prospective randomized study of total parenteral nutrition for long spinal deformity fusions as well as its effect on complications and recovery from postoperative malnutrition was performed. Objectives. To determine whether the administration of total parenteral nutrition to patients undergoing same-day or staged long spinal fusions has an effect on postoperative nutritional parameter depletion, time for return to preoperative nutritional baseline, and complication rate. Summary of Background Data. Several studies have suggested, but only one has demonstrated, that perioperative administration of total parenteral nutrition to patients undergoing spinal reconstructive surgery may reduce postoperative nutritional depletion, thereby decreasing postoperative complications. Methods. In this study, 46 patients undergoing same-day or staged spinal reconstruction surgery (greater than or equal to 10 levels) were randomized to receive or not receive total parenteral nutrition after surgery. The nutritional parameters of albumin, prealbumin, transferrin, total protein, and absolute lymphocyte count were obtained before surgery and at regular intervals after surgery until at least four out of five parameters were within 10% of their preoperative baseline value. Perioperative data and complications were tallied. Results. There were no complications related to total parenteral nutrition administration. There was no statistical difference in total complications between those who did and those who did not receive total parenteral nutrition. However, there was a trend (P < 0.073) for the total parenteral nutrition group to return to nutritional baseline quicker. A significant increase in transferrin (P < 0.0082) and prealbumin (P < 0.015) depletion occurred in the patients who did not receive total parenteral nutrition. The anterior/posterior-same-day patients receiving total parenteral nutrition had more major complications (P < 0.033) and significantly more total protein depletion (P < 0.018) than the anterior/posterior-staged patients receiving total parenteral nutrition, possibly because the anterior/posterior-staged group received significantly more days(P < 0.0155) of total parenteral nutrition than the anterior/posterior-same-day group. In controlling for the number of days of total parenteral nutrition, no significant difference between type of surgery and complications was found. Conclusions. The administration of postoperative total parenteral nutrition to patients with spinal deformity is safe. No statistical reduction in complications occurred in the total parenteral nutrition group despite a trend toward more sapid normalization of nutritional parameters and a decrease in postoperative nutritional depletion. The anterior/pasterior-staged group with the administration of total parenteral nutrition had a lower overall complication rate and a decreased incidence of postoperative nutritional depletion than the one-stage reconstruction group. The difference in the complication rates between the two groups may relate as much to the staging as to the administration of total parenteral nutrition per se. For certain cases it may be more advisable to stage patients and deliver total parenteral nutrition than to manage the cases in a continuous (i.e., same-day) fashion.