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Clinical nutrition, enteral and parenteral nutrition

Preoperative immunonutrition and its effect on postoperative outcomes in well-nourished and malnourished gastrointestinal surgery patients: a randomised controlled trial

European Journal of Clinical Nutrition volume 67, pages 802–807 (2013)Cite this article

Subjects

Abstract

Background/Objectives:

Invasive procedures such as surgery cause immunosuppression, leading to increased risk of complications, infections and extended hospital stay. Emerging research around immune-enhancing nutrition supplements and their ability to reduce postoperative complications and reduce treatment costs is promising. This randomised controlled trial aims to examine the effect of preoperative immunonutrition supplementation on length of hospital stay (LOS), complications and treatment costs in both well-nourished and malnourished gastrointestinal surgery patients.

Subjects/Methods:

Ninety-five patients undergoing elective upper and lower gastrointestinal surgery were recruited. The treatment group (n=46) received a commercial immuno-enhancing supplement 5 days preoperatively. The control group (n=49) received no supplements. The primary outcome measure was LOS, and secondary outcome measures included complications and cost.

Results:

A nonsignificant trend towards a shorter LOS within the treatment group was observed (7.1±4.1 compared with 8.8±6.5 days; P=0.11). For malnourished patients, this trend was greater with hospital stay reduced by 4 days (8.3±3.5 vs 12.3±9.5 days; P=0.21). Complications and unplanned intensive care admission rates were very low in both the groups. The average admission cost was reduced by AUD1576 in the treatment group compared with the control group (P=0.37).

Conclusions:

Preoperative immunonutrition therapy in gastrointestinal surgery has the potential to reduce the LOS and cost, with greater treatment benefit seen in malnourished patients; however, there is a need for additional research with greater patient numbers.

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Acknowledgements

We thank Ms Eliza Jervis-Read for assistance with the data collection and Mr Jarrod Barker for assistance with the data analysis. No funding was sought to conduct this study. All supplements used during the trial were purchased by the Nutrition Department. No funding has been received from Nestle Medical Nutrition, and nor have they had input into study design or results analysis.

Authors contributions

LAB designed and co-ordinated the study, participated in the patient recruitment and data collection, carried out the data analysis and drafted the manuscript. LW participated in the patient recruitment. CG carried out the data collection. SS and BNJT assisted with the study design. TC participated in the study design, assisted with the data analysis and the manuscript drafting. All the authors read and approved the final manuscript.

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Authors and Affiliations

  1. Nutrition Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia

    L A Barker

  2. School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia

    C Gray & T C Crowe

  3. Department of General Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia

    L Wilson, B N J Thomson & S Shedda

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  1. L A Barker
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  2. C Gray
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Correspondence to L A Barker.

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Barker, L., Gray, C., Wilson, L. et al. Preoperative immunonutrition and its effect on postoperative outcomes in well-nourished and malnourished gastrointestinal surgery patients: a randomised controlled trial. Eur J Clin Nutr 67, 802–807 (2013). https://doi.org/10.1038/ejcn.2013.117

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