Nutritional depletion in staged spinal reconstructive surgery - The effect of total parenteral nutrition

Study Design. A prospective randomized study evaluating nutritional depletion in spine surgery patients. Objective. To determine whether use of total parenteral nutrition (TPN) in patients undergoing staged spinal reconstructive procedures could affect their nutritional parameters or decrease their complication rates. Summary of Background Data. Several studies have shown that nutritional depletion occurs after major spinal surgery and that patients undergoing staged spinal surgery may be at particular risk of nutritional loss and its complications. Methods. Forty adult patients undergoing staged spinal reconstructive surgery were randomized as to whether they received TPN postoperatively. Nutritional parameters, including skin fold measurement and albumin, pre-albumin, transferrin, and total lymphocyte counts, were obtained pre-operatively and at regular intervals. Results. Five patients did not complete the study, leaving 35 patients for analysis. There was a significant decrease in incidence of albumin and pre-albumin depletion for the patients who did not receive TPN compared with those who did receive TPN (P < 0.025, P < 0.006, respectively). Patients with depleted albumin or pre-albumin counts were more likely to develop other postoperative infectious complications such as pneumonia or urinary tract infections (P < 0.035). There were no statistically significant differences in wound complications in this small patient study. There were no complications secondary to use of the TPN. Conclusions. For complex patients requiring staged anterior/posterior surgery, TPN appears to significantly lessen the decrease in nutritional parameters. Because depletion of nutritional parameters appears to correlate with an increased likelihood of perioperative infectious complications, use of TPN may result in a decrease of such complications in these patients.