NUTRITIONAL DEPLETION IN STAGED SPINAL RECONSTRUCTIVE SURGERY - THE EFFECT OF TOTAL PARENTERAL-NUTRITION

Study Design. A prospective randomized study evaluating nutritional de pletion in spine surgery patients. Objective. To determine whether use of total parenteral nutrition (TPN) in patients undergoing staged spi nal reconstructive procedures could affect their nutritional parameter s or decrease their complication rates. Summary of Background Data. Se veral 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. Meth ods. Forty adult patients undergoing staged spinal reconstructive surg ery were randomized as to whether they received TPN postoperatively. N utritional parameters, including skin fold measurement and albumin, pr e-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 sign ificant decrease in incidence of albumin and pre-albumin depletion for the patients who did not receive TPN compared with those who did rece ive TPN (P < 0.025, P < 0.006, respectively). Patients with depleted a lbumin or pre-albumin counts were more likely to develop other postope rative infectious complications such as pneumonia or urinary tract inf ections (P < 0.035). There were no statistically significant differenc es in wound complications in this small patient study. There were no c omplications secondary to use of the TPN. Conclusions. For complex pat ients requiring staged anterior/posterior surgery, TPN appears to sign ificantly lessen the decrease in nutritional parameters. Because deple tion of nutritional parameters appears to correlate with an increased likelihood of perioperative infectious complications, use of TPN may r esult in a decrease of such complications in these patients.