{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T07:05:13Z","timestamp":1779433513189,"version":"3.53.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High-risk open abdomen (OA) patients with acute gastrointestinal injury (AGI) and persistent enteral nutrition (EN) intolerance are particularly vulnerable to cumulative energy-protein deficit, yet the optimal timing of supplemental parenteral nutrition (SPN) remains uncertain. We evaluated whether earlier SPN initiation was associated with a lower subsequent incidence of enteroatmospheric fistula (EAF) in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single-center retrospective cohort study of adult OA patients admitted to the intensive care unit between January 2019 and December 2024 who had AGI grade II-III, persistent EN intolerance by ICU Day 3, and a modified Nutrition Risk in the Critically Ill score of at least 5. Using ICU Day 7 as the landmark time point, patients who initiated SPN between ICU Days 3 and 7 were classified as the early-SPN group, and those who initiated SPN after ICU Day 7 as the late-SPN group. Patients who never received SPN were intentionally excluded to focus the analysis on the optimal timing among those who definitively required supplementation. One-to-one propensity score matching was performed. The primary outcome was EAF occurring after ICU Day 7.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 355 screened patients, 284 met the eligibility criteria, including 110 early-SPN and 174 late-SPN patients; 102 matched pairs were analyzed. During ICU Days 3\u20137, the early-SPN group received higher energy and protein delivery. EAF occurred in 13\/102 patients (12.75%) in the early-SPN group and 31\/102 (30.39%) in the late-SPN group (relative risk, 0.42; 95% CI, 0.23\u20130.75;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002). In an exploratory landmark time-to-event analysis, early SPN was associated with a lower subsequent hazard of EAF (HR, 0.39; 95% CI, 0.21\u20130.75; log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003). Mechanical ventilation duration was shorter in the early-SPN group (8.27\u202f\u00b1\u202f10.53 vs. 12.00\u202f\u00b1\u202f13.80\u202fdays,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.031), whereas other secondary outcomes were comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among high-risk OA patients with AGI and persistent EN intolerance who subsequently required SPN, initiation of SPN between ICU Days 3 and 7 was associated with improved short-term nutritional delivery, shorter mechanical ventilation duration, and a lower subsequent incidence of EAF than later SPN initiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1845342","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T06:10:00Z","timestamp":1779430200000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early supplemental parenteral nutrition and risk of subsequent enteroatmospheric fistula in high-risk open abdomen patients with persistent enteral nutrition intolerance: a landmark propensity score-matched cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Wenyue","family":"Wang","sequence":"first","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongliang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s13017-018-0167-4","article-title":"The open abdomen in trauma and non-trauma patients: WSES guidelines","volume":"13","author":"Coccolini","year":"2018","journal-title":"World J Emerg 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Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1845342\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T06:10:00Z","timestamp":1779430200000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1845342\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":35,"alternative-id":["10.3389\/fmed.2026.1845342"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1845342","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]},"article-number":"1845342"}}