Limited Routine Total Parenteral Nutrition versus oral diet progression post Whipple procedure to assess affect on patient functionality

All patients will follow the RPA Whipple’s protocol for oral diet progression. Oral diet: NBM day 0-1, Clear Fluid diet day 2-4, Full Fluid diet day 3-5, Post Gastrectomy diet day >4. Where clear diet is clear liquids only, full fluid diet is opaque liquids only and post gastrectomy diet is a diet and meal frequency appropriate for patients in the early post-operative phase after a gastrectomy or oesophagogastrectomy, and to minimise risk of dumping syndrome or oesophageal blockage (as per NSW Agency of Clinical Innovation diet specifications] . The intervention group (n = 10) patients will be placed on TPN within 24hrs post pancreaticoduodenectomy with oral diet progression. TPN will be calculated to meet patient’s estimated nutritional requirements using Schofield Equation. TPN will be titrated to goal rate using existing practice as per hospital policy “Parental Nutrition (ICU patients)”.TPN will be given via pre-existing central line inserted pre-op. IV fluids given to intervention arm as per RPA Hospital Pancreaticoduodenectomy Checklist [IVT Day 0 post-operatively use Hartman’s Solution. Chart rate at 150mls/hour and on the ward if a fluid bolus is required, the preference is to use 100mls 20% Albumin] Diet progression: Day 0-1: NBM + TPN goal rate Day 2-4: Clear Fluid diet + TPN goal rate Day 3-5: Full Fluid diet + TPN half goal rate Day > 4: Post Gastrectomy diet + TPN half goal rate or ceased In addition to the above as deeded appropriate by the medical team, the patients may receive: IV fluids to meet hydration needs, oral nutritional supplements as appropriate (if oral intake is inadequate to meet estimated nutritional requirements alone). The number of days from initial surgery to when the TPN is ceased will be recorded. Measurement data will be stored via a secure method within REDCap. The pre-operative and intra-operative data is already collected by the Hospital Upper Gastrointestinal Outcomes database (HUGO) (Protocol No X16-0068 & HREC/16/RPAH/84). Baseline: Weight, BMI, Grip strength, QOL questionnaire [EQ-5D-5L] and 24hr food recall. Day 1 post-op: Subjective Global Assessment (SGA) Day 3: Grip strength, weight, BMI, % weight loss, 24hrs dietary recall on total calorie + protein intake and TPN nutritional contributions. Complications. QOL questionnaire [EQ-5D-5L]. Drain/serum Amylase levels. Day 5: Drain/serum Amylase levels Day 7: Grip strength, weight, BMI, % weight loss, 24hrs dietary recall on total calorie + protein intake and TPN nutritional contributions. QOL questionnaire. [EQ-5D-5L]. Day of discharge: postoperative complications and length of stay. One month post-discharge: number of complication free days, SGA and hand grip strength. To be collected in the Gastro Dietetics Outpatient Clinic. QOL questionnaire [EQ-5D-5L] One assessor will be collecting the data; Kiah Witney-Cochrane.