CI: Enteral Nutrition vs. Parenteral Nutrition (2012)

Citation:

Trice S, Melnik G, Page G. Complications and costs of early postoperative parenteral versus enteral nurition in trauma patients. Nutrition in Clinical Practice 1997. 12 (3) 114-119.

 
Study Design:
Retrospective, cost effectiveness analysis
Class:
M - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:
To compare the cost effectiveness of total enteral nutrition (TEN) vs. total parenteral nutrition (TPN) in the nutritional care of trauma patients.
Inclusion Criteria:
The authors did not specify which inclusion or exclusion criteria were adopted for the review.
Exclusion Criteria:
Not given.
Description of Study Protocol:

Two studies were included in the review. 

  • The first was a published meta-analysis combining data on septic complications from eight prospective randomized trials from eight different sites comparing TEN with TPN in moderately to severely stressed post-operative patients 
  • The second study was a RCT on blunt and penetrating trauma patients with abdominal trauma index greater than or equal to 15 and TEN or TPN started with 24 hours of surgery.
Data Collection Summary:
  • Frequency of infection complications and gastrointestinal complications associated with TEN or TPN in randomized patients
  • Odds ratios and 95% confidence intervals were used to examine the data set
  • Only hospital costs were considered. Costs were standardized to 1996 wholesale costs from the two previous published studies.
Description of Actual Data Sample:
Summary of Results:
  • Patients receiving TPN have a 3.84 greater risk of developing infectious complications and 15 times greater risk of developing a catheter sepsis than those receiving TEN. Total parenteral nutrition was found to be from four to 12.5 times more expensive then TEN.
  • Total pooled septic complications in patients randomized to post-operative TEN or TPN were reported to be 36 and 80 events, respectively (odds ratio 3.84; 95% CI 2.37-6.23). Total pooled rates of diarrhea were 51 (TEN) and 17 (TPN) (odds ratio, 3.56; 95% CI 1.95-6.49) and rates of abdominal distention were 54 (TEN) and 27 (TPN) giving an odds ratio of 2.66 (95% CI: 1.51-4.68).
Author Conclusion:
  • Increased risk with TPN vs. TEN in regard to septic complications and associated increased cost of therapy
  • Patients should be carefully evaluated (risk/benefit) before initiating TPN
  • Significant economic cost savings with enteral nutrition vs. parenteral nutrition.
Funding Source:
University/Hospital: University of Texas at Austin; University of Texas Health Science Center at SanAntonio, South Texas VA Health Care System
Reviewer Comments:
  • Pooled studies from Moore (1992) and Kudsk (1992)
  • Costs may not be applicable today due to changes in costs associated with TPN and medications.
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes