The impact of post-operative enteral nutrition on duodenal injury outcomes: A post hoc analysis of an EAST multicenter trial.

Rachel L Choron; Michael Rallo; Charoo Piplani; Sara Youssef; Amanda L Teichman; Christopher G Bargoud; Jason D Sciarretta; Randi N Smith; Dustin S Hanos; Iman N Afif; Jessica H Beard; Navpreet K Dhillon; Ashling Zhang; Mira Ghneim; Rebekah J Devasahayam; Oliver L Gunter; Alison A Smith; Brandi L Sun; Chloe Cao; Jessica K Reynolds; Lauren A Hilt; Daniel Holena; Grace Chang; Meghan Jonikas; Karla Echeverria; Nathaniel Fung; Aaron Anderson; Ryan P Dumas; Caitlin A Fitzgerald; Jeremy Levin; Christine Trankiem; JaeHee Jane Yoon; Jacqueline Blank; Joshua Hazelton; Christopher J McLaughlin; Rami Al-Aref; Jordan M Kirsch; Daniel S Howard; Dane R Scantling; Kate Dellonte; Michael Vella; Brent Hopkins; Chloe Shell; Pascal O Udekwu; Evan G Wong; Bellal A Joseph; Howard Lieberman; Walter Ramsey; Collin Stewart; Claudia Alvarez; John D Berne; Jeffry Nahmias; Ivan Puente; J Pat Patton; Ilya Rakitin; Lindsey L Perea; Odessa R Pulido; Hashim Ahmed; Jane Keating; Lisa Kodadek; Jason Wade; Reynold Henry; Martin Schreiber; Andrew Benjamin; Abid Khan; Laura K Mann; Caleb Mentzer; Vasileios Mousafeiris; Francesk Mulita; Shari Reid-Gruner; Erica Sais; Christopher Foote; Carlos Palacio-Lascano; Dias Argandykov; Haytham Kaafarani; Michelle Bover Manderski; Mayur Narayan; Mark J Seamon

doi:10.1097/TA.0000000000004303

The impact of post-operative enteral nutrition on duodenal injury outcomes: A post hoc analysis of an EAST multicenter trial.

Rachel L Choron, Michael Rallo, Charoo Piplani, Sara Youssef, Amanda L Teichman, Christopher G Bargoud, Jason D Sciarretta, Randi N Smith, Dustin S Hanos, Iman N Afif, Jessica H Beard, Navpreet K Dhillon, Ashling Zhang, Mira Ghneim, Rebekah J Devasahayam, Oliver L Gunter, Alison A Smith, Brandi L Sun, Chloe Cao, Jessica K ReynoldsLauren A Hilt, Daniel Holena, Grace Chang, Meghan Jonikas, Karla Echeverria, Nathaniel Fung, Aaron Anderson, Ryan P Dumas, Caitlin A Fitzgerald, Jeremy Levin, Christine Trankiem, JaeHee Jane Yoon, Jacqueline Blank, Joshua Hazelton, Christopher J McLaughlin, Rami Al-Aref, Jordan M Kirsch, Daniel S Howard, Dane R Scantling, Kate Dellonte, Michael Vella, Brent Hopkins, Chloe Shell, Pascal O Udekwu, Evan G Wong, Bellal A Joseph, Howard Lieberman, Walter Ramsey, Collin Stewart, Claudia Alvarez, John D Berne, Jeffry Nahmias, Ivan Puente, J Pat Patton, Ilya Rakitin, Lindsey L Perea, Odessa R Pulido, Hashim Ahmed, Jane Keating, Lisa Kodadek, Jason Wade, Reynold Henry, Martin Schreiber, Andrew Benjamin, Abid Khan, Laura K Mann, Caleb Mentzer, Vasileios Mousafeiris, Francesk Mulita, Shari Reid-Gruner, Erica Sais, Christopher Foote, Carlos Palacio-Lascano, Dias Argandykov, Haytham Kaafarani, Michelle Bover Manderski, Mayur Narayan, Mark J Seamon

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Leak following surgical repair of traumatic duodenal injuries results in prolonged hospitalization and oftentimes nil per os(NPO) treatment. Parenteral nutrition(PN) has known morbidity; however, duodenal leak(DL) patients often have complex injuries and hospital courses resulting in barriers to enteral nutrition(EN). We hypothesized EN alone would be associated with 1)shorter duration until leak closure and 2)less infectious complications and shorter hospital length of stay(HLOS) compared to PN.

METHODS: This was a post-hoc analysis of a retrospective, multicenter study from 35 Level-1 trauma centers, including patients >14 years-old who underwent surgery for duodenal injuries(1/2010-12/2020) and endured post-operative DL. The study compared nutrition strategies: EN vs PN vs EN + PN using Chi-Square and Kruskal-Wallis tests; if significance was found pairwise comparison or Dunn's test were performed.

RESULTS: There were 113 patients with DL: 43 EN, 22 PN, and 48 EN + PN. Patients were young(median age 28 years-old) males(83.2%) with penetrating injuries(81.4%). There was no difference in injury severity or critical illness among the groups, however there were more pancreatic injuries among PN groups. EN patients had less days NPO compared to both PN groups(12 days[IQR23] vs 40[54] vs 33[32],p = p = 0.008). Enteral nutrition patients had less intra-abdominal abscesses, bacteremia, and days with drains than the PN groups (all p < 0.05). Hospital length of stay was shorter among EN patients versus both PN groups (27 days [24] vs. 44 [62] days vs. 45 [31] days, p = 0.001). When controlling for predictors of leak, regression analysis demonstrated that EN was associated with shorter hospital length of stay (β = −24.9; 95% confidence interval, −39.0 to −10.7; p < 0.001).

CONCLUSION: EN was associated with a shorter duration until leak closure, less infectious complications, and shorter length of stay. Contrary to some conventional thought, PN was not associated with decreased time until leak closure. We therefore suggest EN should be the preferred choice of nutrition in patients with duodenal leaks whenever feasible.

LEVEL OF EVIDENCE: Therapeutic/Care Management; IV.

Original language	American English
Journal	Journal of Trauma and Acute Care Surgery
DOIs	https://doi.org/10.1097/TA.0000000000004303
State	Published - May 15 2024

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Choron, R. L., Rallo, M., Piplani, C., Youssef, S., Teichman, A. L., Bargoud, C. G., Sciarretta, J. D., Smith, R. N., Hanos, D. S., Afif, I. N., Beard, J. H., Dhillon, N. K., Zhang, A., Ghneim, M., Devasahayam, R. J., Gunter, O. L., Smith, A. A., Sun, B. L., Cao, C., ... Seamon, M. J. (2024). The impact of post-operative enteral nutrition on duodenal injury outcomes: A post hoc analysis of an EAST multicenter trial. Journal of Trauma and Acute Care Surgery. https://doi.org/10.1097/TA.0000000000004303

Choron, RL, Rallo, M, Piplani, C, Youssef, S, Teichman, AL, Bargoud, CG, Sciarretta, JD, Smith, RN, Hanos, DS, Afif, IN, Beard, JH, Dhillon, NK, Zhang, A, Ghneim, M, Devasahayam, RJ, Gunter, OL, Smith, AA, Sun, BL, Cao, C, Reynolds, JK, Hilt, LA, Holena, D, Chang, G, Jonikas, M, Echeverria, K, Fung, N, Anderson, A, Dumas, RP, Fitzgerald, CA, Levin, J, Trankiem, C, Yoon, JJ, Blank, J, Hazelton, J, McLaughlin, CJ, Al-Aref, R, Kirsch, JM, Howard, DS, Scantling, DR, Dellonte, K, Vella, M, Hopkins, B, Shell, C, Udekwu, PO, Wong, EG, Joseph, BA, Lieberman, H, Ramsey, W, Stewart, C, Alvarez, C, Berne, JD, Nahmias, J, Puente, I, Patton, JP, Rakitin, I, Perea, LL, Pulido, OR, Ahmed, H, Keating, J, Kodadek, L, Wade, J, Henry, R, Schreiber, M, Benjamin, A, Khan, A, Mann, LK, Mentzer, C, Mousafeiris, V, Mulita, F, Reid-Gruner, S, Sais, E, Foote, C, Palacio-Lascano, C, Argandykov, D, Kaafarani, H, Bover Manderski, M, Narayan, M & Seamon, MJ 2024, 'The impact of post-operative enteral nutrition on duodenal injury outcomes: A post hoc analysis of an EAST multicenter trial.', Journal of Trauma and Acute Care Surgery. https://doi.org/10.1097/TA.0000000000004303

@article{94b1733cad354e93b5d70d7d510605cb,

title = "The impact of post-operative enteral nutrition on duodenal injury outcomes: A post hoc analysis of an EAST multicenter trial.",

abstract = "BACKGROUND: Leak following surgical repair of traumatic duodenal injuries results in prolonged hospitalization and oftentimes nil per os(NPO) treatment. Parenteral nutrition(PN) has known morbidity; however, duodenal leak(DL) patients often have complex injuries and hospital courses resulting in barriers to enteral nutrition(EN). We hypothesized EN alone would be associated with 1)shorter duration until leak closure and 2)less infectious complications and shorter hospital length of stay(HLOS) compared to PN. METHODS: This was a post-hoc analysis of a retrospective, multicenter study from 35 Level-1 trauma centers, including patients >14 years-old who underwent surgery for duodenal injuries(1/2010-12/2020) and endured post-operative DL. The study compared nutrition strategies: EN vs PN vs EN + PN using Chi-Square and Kruskal-Wallis tests; if significance was found pairwise comparison or Dunn's test were performed. RESULTS: There were 113 patients with DL: 43 EN, 22 PN, and 48 EN + PN. Patients were young(median age 28 years-old) males(83.2\%) with penetrating injuries(81.4\%). There was no difference in injury severity or critical illness among the groups, however there were more pancreatic injuries among PN groups. EN patients had less days NPO compared to both PN groups(12 days[IQR23] vs 40[54] vs 33[32],p = p = 0.008). Enteral nutrition patients had less intra-abdominal abscesses, bacteremia, and days with drains than the PN groups (all p < 0.05). Hospital length of stay was shorter among EN patients versus both PN groups (27 days [24] vs. 44 [62] days vs. 45 [31] days, p = 0.001). When controlling for predictors of leak, regression analysis demonstrated that EN was associated with shorter hospital length of stay (β = −24.9; 95\% confidence interval, −39.0 to −10.7; p < 0.001). CONCLUSION: EN was associated with a shorter duration until leak closure, less infectious complications, and shorter length of stay. Contrary to some conventional thought, PN was not associated with decreased time until leak closure. We therefore suggest EN should be the preferred choice of nutrition in patients with duodenal leaks whenever feasible. LEVEL OF EVIDENCE: Therapeutic/Care Management; IV.",

author = "Choron, \{Rachel L\} and Michael Rallo and Charoo Piplani and Sara Youssef and Teichman, \{Amanda L\} and Bargoud, \{Christopher G\} and Sciarretta, \{Jason D\} and Smith, \{Randi N\} and Hanos, \{Dustin S\} and Afif, \{Iman N\} and Beard, \{Jessica H\} and Dhillon, \{Navpreet K\} and Ashling Zhang and Mira Ghneim and Devasahayam, \{Rebekah J\} and Gunter, \{Oliver L\} and Smith, \{Alison A\} and Sun, \{Brandi L\} and Chloe Cao and Reynolds, \{Jessica K\} and Hilt, \{Lauren A\} and Daniel Holena and Grace Chang and Meghan Jonikas and Karla Echeverria and Nathaniel Fung and Aaron Anderson and Dumas, \{Ryan P\} and Fitzgerald, \{Caitlin A\} and Jeremy Levin and Christine Trankiem and Yoon, \{JaeHee Jane\} and Jacqueline Blank and Joshua Hazelton and McLaughlin, \{Christopher J\} and Rami Al-Aref and Kirsch, \{Jordan M\} and Howard, \{Daniel S\} and Scantling, \{Dane R\} and Kate Dellonte and Michael Vella and Brent Hopkins and Chloe Shell and Udekwu, \{Pascal O\} and Wong, \{Evan G\} and Joseph, \{Bellal A\} and Howard Lieberman and Walter Ramsey and Collin Stewart and Claudia Alvarez and Berne, \{John D\} and Jeffry Nahmias and Ivan Puente and Patton, \{J Pat\} and Ilya Rakitin and Perea, \{Lindsey L\} and Pulido, \{Odessa R\} and Hashim Ahmed and Jane Keating and Lisa Kodadek and Jason Wade and Reynold Henry and Martin Schreiber and Andrew Benjamin and Abid Khan and Mann, \{Laura K\} and Caleb Mentzer and Vasileios Mousafeiris and Francesk Mulita and Shari Reid-Gruner and Erica Sais and Christopher Foote and Carlos Palacio-Lascano and Dias Argandykov and Haytham Kaafarani and \{Bover Manderski\}, Michelle and Mayur Narayan and Seamon, \{Mark J\}",

year = "2024",

month = may,

day = "15",

doi = "10.1097/TA.0000000000004303",

language = "American English",

journal = "Journal of Trauma and Acute Care Surgery",

}

TY - JOUR

T1 - The impact of post-operative enteral nutrition on duodenal injury outcomes: A post hoc analysis of an EAST multicenter trial.

AU - Choron, Rachel L

AU - Rallo, Michael

AU - Piplani, Charoo

AU - Youssef, Sara

AU - Teichman, Amanda L

AU - Bargoud, Christopher G

AU - Sciarretta, Jason D

AU - Smith, Randi N

AU - Hanos, Dustin S

AU - Afif, Iman N

AU - Beard, Jessica H

AU - Dhillon, Navpreet K

AU - Zhang, Ashling

AU - Ghneim, Mira

AU - Devasahayam, Rebekah J

AU - Gunter, Oliver L

AU - Smith, Alison A

AU - Sun, Brandi L

AU - Cao, Chloe

AU - Reynolds, Jessica K

AU - Hilt, Lauren A

AU - Holena, Daniel

AU - Chang, Grace

AU - Jonikas, Meghan

AU - Echeverria, Karla

AU - Fung, Nathaniel

AU - Anderson, Aaron

AU - Dumas, Ryan P

AU - Fitzgerald, Caitlin A

AU - Levin, Jeremy

AU - Trankiem, Christine

AU - Yoon, JaeHee Jane

AU - Blank, Jacqueline

AU - Hazelton, Joshua

AU - McLaughlin, Christopher J

AU - Al-Aref, Rami

AU - Kirsch, Jordan M

AU - Howard, Daniel S

AU - Scantling, Dane R

AU - Dellonte, Kate

AU - Vella, Michael

AU - Hopkins, Brent

AU - Shell, Chloe

AU - Udekwu, Pascal O

AU - Wong, Evan G

AU - Joseph, Bellal A

AU - Lieberman, Howard

AU - Ramsey, Walter

AU - Stewart, Collin

AU - Alvarez, Claudia

AU - Berne, John D

AU - Nahmias, Jeffry

AU - Puente, Ivan

AU - Patton, J Pat

AU - Rakitin, Ilya

AU - Perea, Lindsey L

AU - Pulido, Odessa R

AU - Ahmed, Hashim

AU - Keating, Jane

AU - Kodadek, Lisa

AU - Wade, Jason

AU - Henry, Reynold

AU - Schreiber, Martin

AU - Benjamin, Andrew

AU - Khan, Abid

AU - Mann, Laura K

AU - Mentzer, Caleb

AU - Mousafeiris, Vasileios

AU - Mulita, Francesk

AU - Reid-Gruner, Shari

AU - Sais, Erica

AU - Foote, Christopher

AU - Palacio-Lascano, Carlos

AU - Argandykov, Dias

AU - Kaafarani, Haytham

AU - Bover Manderski, Michelle

AU - Narayan, Mayur

AU - Seamon, Mark J

PY - 2024/5/15

Y1 - 2024/5/15

N2 - BACKGROUND: Leak following surgical repair of traumatic duodenal injuries results in prolonged hospitalization and oftentimes nil per os(NPO) treatment. Parenteral nutrition(PN) has known morbidity; however, duodenal leak(DL) patients often have complex injuries and hospital courses resulting in barriers to enteral nutrition(EN). We hypothesized EN alone would be associated with 1)shorter duration until leak closure and 2)less infectious complications and shorter hospital length of stay(HLOS) compared to PN. METHODS: This was a post-hoc analysis of a retrospective, multicenter study from 35 Level-1 trauma centers, including patients >14 years-old who underwent surgery for duodenal injuries(1/2010-12/2020) and endured post-operative DL. The study compared nutrition strategies: EN vs PN vs EN + PN using Chi-Square and Kruskal-Wallis tests; if significance was found pairwise comparison or Dunn's test were performed. RESULTS: There were 113 patients with DL: 43 EN, 22 PN, and 48 EN + PN. Patients were young(median age 28 years-old) males(83.2%) with penetrating injuries(81.4%). There was no difference in injury severity or critical illness among the groups, however there were more pancreatic injuries among PN groups. EN patients had less days NPO compared to both PN groups(12 days[IQR23] vs 40[54] vs 33[32],p = p = 0.008). Enteral nutrition patients had less intra-abdominal abscesses, bacteremia, and days with drains than the PN groups (all p < 0.05). Hospital length of stay was shorter among EN patients versus both PN groups (27 days [24] vs. 44 [62] days vs. 45 [31] days, p = 0.001). When controlling for predictors of leak, regression analysis demonstrated that EN was associated with shorter hospital length of stay (β = −24.9; 95% confidence interval, −39.0 to −10.7; p < 0.001). CONCLUSION: EN was associated with a shorter duration until leak closure, less infectious complications, and shorter length of stay. Contrary to some conventional thought, PN was not associated with decreased time until leak closure. We therefore suggest EN should be the preferred choice of nutrition in patients with duodenal leaks whenever feasible. LEVEL OF EVIDENCE: Therapeutic/Care Management; IV.

AB - BACKGROUND: Leak following surgical repair of traumatic duodenal injuries results in prolonged hospitalization and oftentimes nil per os(NPO) treatment. Parenteral nutrition(PN) has known morbidity; however, duodenal leak(DL) patients often have complex injuries and hospital courses resulting in barriers to enteral nutrition(EN). We hypothesized EN alone would be associated with 1)shorter duration until leak closure and 2)less infectious complications and shorter hospital length of stay(HLOS) compared to PN. METHODS: This was a post-hoc analysis of a retrospective, multicenter study from 35 Level-1 trauma centers, including patients >14 years-old who underwent surgery for duodenal injuries(1/2010-12/2020) and endured post-operative DL. The study compared nutrition strategies: EN vs PN vs EN + PN using Chi-Square and Kruskal-Wallis tests; if significance was found pairwise comparison or Dunn's test were performed. RESULTS: There were 113 patients with DL: 43 EN, 22 PN, and 48 EN + PN. Patients were young(median age 28 years-old) males(83.2%) with penetrating injuries(81.4%). There was no difference in injury severity or critical illness among the groups, however there were more pancreatic injuries among PN groups. EN patients had less days NPO compared to both PN groups(12 days[IQR23] vs 40[54] vs 33[32],p = p = 0.008). Enteral nutrition patients had less intra-abdominal abscesses, bacteremia, and days with drains than the PN groups (all p < 0.05). Hospital length of stay was shorter among EN patients versus both PN groups (27 days [24] vs. 44 [62] days vs. 45 [31] days, p = 0.001). When controlling for predictors of leak, regression analysis demonstrated that EN was associated with shorter hospital length of stay (β = −24.9; 95% confidence interval, −39.0 to −10.7; p < 0.001). CONCLUSION: EN was associated with a shorter duration until leak closure, less infectious complications, and shorter length of stay. Contrary to some conventional thought, PN was not associated with decreased time until leak closure. We therefore suggest EN should be the preferred choice of nutrition in patients with duodenal leaks whenever feasible. LEVEL OF EVIDENCE: Therapeutic/Care Management; IV.

U2 - 10.1097/TA.0000000000004303

DO - 10.1097/TA.0000000000004303

M3 - Article

C2 - 38745354

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

ER -