90th Annual Meeting Abstracts
Total Parenteral Nutrition (TPN) in the Geriatric Trauma Population
*Louise Jackson, MD, *Daithi S. Heffernan, MD AFRCSI, *Elizabeth Hagan, RN, *Marion Winkler, PhD, *Jorge Albina, MD, *William G Cioffi, MD
Department of Surgery, Rhode Island Hospital, Providence, RI
Objective: The US population is rapidly aging and sustaining significant trauma. Nutrition is essential to overcoming the metabolic demands of trauma. A dearth of knowledge exists regarding TPN in elderly trauma patients. We describe the pattern of TPN use in a geriatric trauma population.
Design: 3 year retrospective chart review of TPN use in geriatric versus young trauma patients.
Setting: Level 1 trauma center.
Patients: 23 Geriatric (>/=65 years old) and 25 younger (18-35 year olds) trauma patients.
Interventions: Chart Review
Main Outcomes measures: Indication for TPN, time to TPN, duration, average calories delivered, overlapping days TPN/enteral nutrition, line infections while on TPN.
Results: 65% geriatric and 92% young patients were male (p=0.03). Geriatric patients received fewer total TPN days (8.2 (+/- 4.4) versus 20.5 (+/-12.7); p=0.002), and fewer non-protein calories (22 (+/-6) kcal/kg versus 29 (+/-10); p=0.004). TPN was started later in the hospital course on geriatric patients at day 16 (+/-5.5) versus day 9 (+/-4.8) in the young patients (p=0.049). Indications for TPN were similar between geriatric and young patients; intolerance of tube feeds 30% versus 50%; multiple operations 20% versus 17%; pressor requirement 15% versus 26%; p=N/S. Significantly more geriatric patients died before transitioning from TPN (40% versus 12%; p=0.045). Geriatric patients transitioned quicker, requiring 4.2 days of Enteral/TPN overlap versus 8 days (p=0.041). Central line infections were similar; 14/28 lines in geriatric patients and 18/40 in young patients (p=0.56).
Conclusion: Geriatric trauma presents unique nutritional challenges. TPN was started later and used for shorter duration with fewer kcal/kg in the geriatric population. Geriatric patients transitioned quicker when possible, but a significant number of patients died before transitioning off TPN.