A randomised controlled trial of preoperative oral immunonutrition in patients undergoing surgery for colorectal cancer: Hospital stay and health care costs

Campillo, María del Carmen Manzanares; Fernández, Jesús Martín; Amo-Salas, Mariano; Rituerto, Daniel Casanova

doi:10.1016/j.circen.2017.11.008

Cited by 13 publications

(18 citation statements)

References 28 publications

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“…The characteristics of the included studies by type of intervention, aggregate data from the included studies by type of intervention, RoB assessment, summary of findings, excluded studies, studies that fit the inclusion criteria but had no usable data, and relevant protocols of ongoing or unpublished studies are shown in the online supplemental digital content. We identified eight types of interventions administered in the preoperative period: nutritional (51 studies),30–80 respiratory (30 interventions of 29 studies)81–109 exercise (27 studies),110–136 multimodal (25 studies),100 108 137–159 educational (17 studies),160–176 psychological (16 studies),177–192 smoking and alcohol cessation (7 studies)193–199 and pharmacological (5 studies)200–204 (table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Nutritional interventions were further subdivided into standard oral nutritional supplements (ONS, 7 studies),30–35 69 oral immunonutrition supplements (19 studies)36–47 70–75 80 weight loss interventions (11 studies),48–51 53–57 76 205 oral prebiotics and probiotics (6 studies),58–61 77 78 dietary optimisation of comorbidities (3 studies)62–64 and other (5 studies, generally including administration of nutritional supplements such as fish oils, antioxidants, etc) 65–68 79. Respiratory interventions were further subdivided into IMT (18 studies),81–95 106 108 109 IS (5 studies)90 96–99 and combined respiratory interventions (7 studies, involving combinations of IMT, IS, other respiratory exercises and physical exercises) 100–105 107…”

Section: Resultsmentioning

confidence: 99%

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Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis

et al. 2021

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ObjectiveTo determine the benefits and harms of pre-admission interventions (prehabilitation) on postoperative outcomes in patients undergoing major elective surgery.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs) (published or unpublished). We searched Medline, Embase, CENTRAL, DARE, HTA and NHS EED, The Cochrane Library, CINAHL, PsychINFO and ISI Web of Science (June 2020).SettingSecondary care.ParticipantsPatients (≥18 years) undergoing major elective surgery (curative or palliative).InterventionsAny intervention administered in the preoperative period with the aim of improving postoperative outcomes.Outcomes and measuresPrimary outcomes were 30-day mortality, hospital length of stay (LoS) and postoperative complications. Secondary outcomes included LoS in intensive care unit or high dependency unit, perioperative morbidity, hospital readmission, postoperative pain, heath-related quality of life, outcomes specific to the intervention, intervention-specific adverse events and resource use.Review methodsTwo authors independently extracted data from eligible RCTs and assessed risk of bias and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Random-effects meta-analyses were used to pool data across trials.Results178 RCTs including eight types of intervention were included. Inspiratory muscle training (IMT), immunonutrition and multimodal interventions reduced hospital LoS (mean difference vs usual care: −1.81 days, 95% CI −2.31 to −1.31; −2.11 days, 95% CI −3.07 to −1.15; −1.67 days, 95% CI −2.31 to −1.03, respectively). Immunonutrition reduced infective complications (risk ratio (RR) 0.64 95% CI 0.40 to 1.01) and IMT, and exercise reduced postoperative pulmonary complications (RR 0.55, 95% CI 0.38 to 0.80, and RR 0.54, 95% CI 0.39 to 0.75, respectively). Smoking cessation interventions reduced wound infections (RR 0.28, 95% CI 0.12 to 0.64).ConclusionsSome prehabilitation interventions may reduce postoperative LoS and complications but the quality of the evidence was low.PROSPERO registration numberCRD42015019191.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis

et al. 2021

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“…Twenty-one studies [ 11 , 13 , 15 – 22 , 25 – 28 , 33 , 36 , 38 – 41 , 44 ] evaluated cost of complications in colonic resection as one of their key outcomes. Thirteen articles [ 12 , 14 , 23 , 24 , 29 – 32 , 34 , 35 , 37 , 42 , 43 ] did not study the cost of complications as a key outcome but contained sufficient complication and financial data to meet inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…The cross-sectional cohort study [ 34 ] was deemed of “acceptable quality” as it is classified as a database study by the SIGN cohort study checklist. The overall risk of bias for the randomized controlled [ 14 ] and the randomized clinical trial [ 29 ] was judged to be low with satisfactory randomization and no evidence of selection bias.…”

Section: Resultsmentioning

confidence: 99%

Financial burden of postoperative complications following colonic resection

et al. 2021

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Background: Colonic resection is a common surgical procedure that is associated with a high rate of postoperative complications. Postoperative complications are expected to be major contributors to hospital costs. Therefore, this systematic review aims to outline the health costs of postoperative complications following colon resection surgery. Methods: MEDLINE, Excerpta Medica database, Cochrane, and Economics literature medical databases were searched from 2010 to 2019 to identify English studies containing an economic evaluation of postoperative complications following colonic resection in adult patients. All surgical techniques and indications for colon resection were included. Eligible study designs included randomized trials, comparative observational studies, and conference abstracts. Results: Thirty-four articles met the eligibility criteria. We found a high overall complication incidence with associated increased costs ranging from $2290 to $43,146. Surgical site infections and anastomotic leak were shown to be associated with greater resource utilization relative to other postoperative complications. Postoperative complications were associated with greater incidence of hospital readmission, which in turn is highlighted as a significant financial burden. Weak evidence demonstrates increased complication incidence and costlier complications with open colon surgery as compared to laparoscopic surgery. Notably, we identified a vast degree of heterogeneity in study design, complication reporting and costing methodology preventing quantitative analysis of cost results. Conclusions: Postoperative complications in colonic resection appear to be associated with a significant financial burden. Therefore, large, prospective, cost-benefit clinical trials investigating preventative strategies, with detailed and consistent methodology and reporting standards, are required to improve patient outcomes and the cost-effectiveness of our health care systems.

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“…One of these studies has shown that 57.88% of patients with malignant tumours are complicated by various levels of malnutrition. The incidence of malnutrition in patients with breast tumour is 20.5% [1] [2] [3]. Both breast cancer itself, as a malignant tumour, and complicated and long-lasting treatment, which covers surgery, chemotherapy, radiotherapy, targeted therapy and endocrine therapy, make breast cancer patients face various nutrition problems at different stages [4] [5] [6] [7].…”

Section: Introductionmentioning

confidence: 99%

A Whole-Course and Multidisciplinary Nutrition Management Model for Breast Cancer: A Typical Case Report

Luo¹,

Shi²,

Liu³

et al. 2021

ABCR

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Breast cancer patients face different nutritional problems at each stage. However, the nutrition of breast cancer patients has not been taken seriously. As a result, some patients cannot tolerate treatment due to poor nutrition, thus affecting the prognosis. This study aims to introduce a typical case to explore the whole-course (started at admission and ended 5 years after surgery) and Multidisciplinary Teams (MDTs) (comprising physician, primary nurse, case manager, nutrition liaison and nutrition specialist nurse) nutritional management mode of breast cancer patients. The patient successfully completed the scheduled treatment by implementing the whole-course and multidisciplinary nutrition management. The mode can prospectively and dynamically estimate the changes in patients' nutritional status, and provide timely nutritional intervention to promote patient outcomes.

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A randomised controlled trial of preoperative oral immunonutrition in patients undergoing surgery for colorectal cancer: Hospital stay and health care costs

Cited by 13 publications

References 28 publications

Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis

Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis

Financial burden of postoperative complications following colonic resection

A Whole-Course and Multidisciplinary Nutrition Management Model for Breast Cancer: A Typical Case Report

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