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Association of routine early supplemental parenteral nutrition with postoperative complications after pancreaticoduodenectomy: a single-center retrospective cohort study
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Soo Yeun Lim
 , Kwang Jun Ryu, Hochang Chae, Hyeong Seok Kim, So Jeong Yoon, Hongbeom Kim, Sang Hyun Shin, Jin Seok Heo, In Woong Han
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Received March 17, 2026 Accepted September 28, 2026 Published online November 3, 2026
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DOI: https://doi.org/10.15747/ACNM.26.0053
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 Abstract
- Purpose
The benefit of routinely providing early supplemental parenteral nutrition (PN) after pancreaticoduodenectomy (PD) remains uncertain. This study examined whether routine supplemental PN on postoperative days 1–3 was associated with postoperative complications. The primary endpoint was major complications (Clavien–Dindo grade III or higher) within 90 days.
Methods
This retrospective study analyzed 927 patients who underwent PD at a single tertiary center from 2014 to 2020: 161 received routine early supplemental PN and 766 did not. Supplemental PN was provided on postoperative days 1–3 alongside progressive oral feeding. Exploratory subgroup and interaction analyses examined diabetes mellitus and sarcopenia status.
Results
Major complication rates did not differ between groups (24.2% vs. 23.5%: adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.61–2.10; P=0.919). Grade B/C postoperative pancreatic fistula (POPF; 22.4% vs. 10.7%, P<0.001) and delayed gastric emptying (DGE; 9.3% vs. 4.3%, P=0.012) were more frequent with supplemental PN in unadjusted comparisons. Neither association remained significant after adjustment for treatment period and baseline differences (adjusted OR, 1.73; 95% CI, 0.86–3.47; P=0.126 for POPF and adjusted OR, 2.50; 95% CI, 0.78–8.03; P=0.125 for DGE). Hospital stay was similar between groups (12.5 days vs. 12.1 days; P=0.547). Diabetes mellitus modified the association between supplemental PN and major complications (P for interaction=0.006), whereas sarcopenia did not.
Conclusion
After adjustment, routine early supplemental PN after PD showed no clear evidence of benefit or harm for 90-day major complications. The higher unadjusted rates of POPF and DGE were attenuated by adjustment. The exploratory findings require prospective validation.
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