Background:

Patients with inflammatory bowel disease (IBD) frequently require surgical intervention for management of complicated or severe disease. This study assessed the impact of perioperative nutritional support on postoperative outcomes and complications in IBD patients with protein-calorie malnutrition (PCM).

Methods:

We conducted a retrospective propensity score-matched study using the Nationwide Readmissions Database from 2010-2018. ICD-9 and ICD-10 codes were used to identify IBD patients with PCM who underwent intestinal surgery during index hospitalization and whether nutritional support (NS) was received via enteral (EN) and/or parenteral nutrition (PN). Using propensity score matching, patients who received NS were matched with patients who did not receive NS based on age, sex, IBD subtype, Charlson Comorbidity Index, elective admission status, patient income, expected insurance coverage, teaching hospital status, urban/rural hospital locality, and PCM severity. Logistic regression and Kaplan-Meier survival analysis were used to compare postoperative outcomes, including 30-day readmission, infection, wound dehiscence, pneumonia, urinary tract infection (UTI), deep venous thrombosis (DVT), central-line associated bloodstream infection (CLABSI), and mortality.

Results:

This study included 30,008 patients with IBD with PCM who underwent intestinal surgery; 15,306 patients received NS during the hospitalization and 14,702 controls did not receive NS. NS was associated with lower odds of 30-day postoperative mortality (OR 0.73, p<0.01) but similar odds of 30-day readmission (OR 1.06, p=0.36). NS was also associated with increased rates of overall infection (OR 1.27, p<0.01), CLABSI (OR 2.21, p=0.001), and DVT (OR 1.28, p=0.01). No significant differences were identified in rates of wound dehiscence, pneumonia, or UTI.

Conclusions:

Utilization of NS in patients with IBD with PCM undergoing intestinal surgery was associated with lower 30-day mortality.  NS was, however, associated with increased infectious complications and DVT. Our findings indicate that perioperative NS has mortality benefit for high-risk IBD patients, particularly when balanced against risks of other postoperative complications.