Perioperative parenteral nutrition in major thoracoabdominal surgery is characterized by sodium overload and multi-electrolyte deficiency, with PN volume, phosphate insufficiency, and surgical complexity identified as key independent determinants of adverse clinical outcomes.
Excessive sodium supplementation occurred in nearly three-quarters of patients on the day of surgery.
Insufficient supplementation of potassium, magnesium, and phosphorus was highly prevalent on the day of surgery.
Nearly half of all patients experienced at least one electrolyte disturbance during the perioperative period.
Potential parenteral nutrition compatibility risks were identified in over 40% of prescriptions on the day of surgery and were associated with longer hospital stay.
Higher parenteral nutrition volume was independently associated with increased risks of electrolyte disturbances, major complications, and prolonged hospitalization.
Phosphate insufficiency was independently associated with prolonged hospital stay and increased risks of electrolyte disturbance and major complications, particularly on postoperative day 1.
Pancreaticoduodenectomy was associated with substantially higher risks of electrolyte disturbances and major complications compared to other thoracoabdominal surgeries.
This research suggests that when patients in China receive intravenous nutrition (parenteral nutrition, or PN) around the time of major chest and abdominal surgery, the electrolyte content of those fluids is frequently mismatched with what guidelines recommend. Specifically, patients tend to receive too much sodium and far too little potassium, magnesium, and phosphorus — with more than 9 in 10 patients receiving inadequate magnesium and phosphorus on the day of surgery. As a result, nearly half of all 2018 patients studied developed at least one measurable electrolyte abnormality, with low calcium, low phosphorus, and low sodium being the most common problems. The study also found that the total volume of parenteral nutrition given, and specifically inadequate phosphorus replacement, were independently linked to worse outcomes — including more complications and longer hospital stays — regardless of how electrolytes were delivered. Additionally, more than 40% of PN prescriptions on the day of surgery had potential chemical compatibility issues, meaning the ingredients in the IV bag may have been at risk of interacting in ways that could reduce effectiveness or safety, and this too was linked to longer hospitalization. Patients undergoing pancreaticoduodenectomy (a complex abdominal operation) faced particularly elevated risks. This research suggests that current real-world practice of perioperative intravenous nutrition in major surgery settings in China deviates substantially from established guidelines, and that improving how much PN is given (avoiding excessive volume), ensuring adequate phosphorus replacement — especially in the first day after surgery — and reducing compatibility risks in IV formulations could meaningfully improve patient recovery and reduce complications. The findings highlight the importance of closer pharmacist and clinical review of PN prescriptions in surgical settings.
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Upload Your LabsHuang Z, Jiang H, Zhu M, Gao C, Jia Z, Shen W, et al.. (2026). Electrolyte supplementation patterns and evaluation in perioperative parenteral nutrition for patients undergoing major thoracoabdominal surgery: A multicenter, observational study.. Medicine. https://doi.org/10.1097/MD.0000000000050590