Associations between parenteral energy or amino acid doses and clinical outcomes in fasting patients undergoing gastroenterological cancer surgery: a nationwide cohort study using real-world data

Background: This study aimed to investigate the associations between parenteral energy/amino acid doses and clinical outcomes in patients who were fasting after gastroenterological cancer surgery. Methods: Patients who were fasting for ≥ 7 days after gastroenterological cancer surgery between 2011 and 2022 were identified in a Japanese medical claims database. The associations between parenteral energy/amino acid doses which are supplied to patients via the peripheral or central vein and clinical adverse events were investigated. Low- (< 0.8 g/kg/day) and high- (≥ 0.8 g/kg/day) amino acid dose groups were compared using propensity score matching (PSM). The primary outcome was clinical adverse events, and secondary outcomes were in-hospital mortality, postoperative complications, decline in activities of daily living, rehospitalization, length of hospital stay, and hospitalization costs. Results: = 0.002). After PSM, 2,585 pairs were formed. Clinical adverse events (42.1% vs 45.1%; odds ratio, 0.88; 95% confidence interval [CI], 0.79-0.99), in-hospital mortality (4.2% vs 5.4%; odds ratio, 0.77; 95% CI, 0.59-0.99), and hospitalization costs (19,788 vs 20,606 USD; regression coefficient, -1,538; 95% CI, -2,250 to -833) were significantly lower in the high-amino acid group. There were no significant differences in other outcomes. Conclusions: Parenteral amino acid dosing may play an important role in improving clinical outcomes in patients after gastroenterological cancer surgery, particularly in those who are fasting for 7 days or longer.