Association between prescribed parenteral energy doses and the composite of clinical adverse events in adult patients after gastrointestinal cancer surgery: A retrospective cohort study

BACKGROUND: We aimed to compare the impact of prescribed parenteral energy on clinical outcomes in patients who exclusively received parenteral nutrition after gastrointestinal cancer surgery. METHODS: We identified patients who exclusively received parenteral nutrition for ≥7 days after surgery using a medical claims database. Based on the mean parenteral energy doses during postoperative days 1-7, patients were divided into restricted-energy (5-10 kcal/kg/day), low-energy (10-20 kcal/kg/day), and standard-energy (20-30 kcal/kg/day) groups. The primary outcome was a composite of clinical adverse events, and secondary outcomes included in-hospital mortality, postoperative complications, declines in activities of daily living, hospital readmission, and length of hospital stay (LOS). Multivariable logistic and multiple regression analyses were employed using the restricted-energy group as the reference. RESULTS: Of 18,294 eligible patients, 6727, 9760, and 1807 were classified into the restricted-, low-, and standard-energy groups, respectively. The adjusted odds ratio (95% confidence interval) for the composite outcome was 1.062 (0.972-1.161; P = 0.18) in the low-energy group and 1.093 (0.942-1.267; P = 0.24) in the standard-energy group. For in-hospital mortality, the adjusted odds ratio was 1.060 (1.057-1.062; P < 0.001) in the low-energy group and 1.281 (1.275-1.287; P < 0.001) in the standard-energy group. The adjusted regression coefficient (95% confidence interval) for LOS was 2.0 (0.7-3.3; P = 0.004) in the low-energy group and 3.2 (1.0-5.5; P = 0.005) in the standard-energy group. No significant differences were observed in other outcomes. CONCLUSION: Early postoperative higher energy doses were associated with increased in-hospital mortality and LOS.