Effect of Perioperative Nutritional Supplementation on Postoperative Complications—Systematic Review and Meta-Analysis

Zhang, Betty; Najarali, Zainab; Ruo, Leyo; Alhusaini, Abdullah; Solis, Natalie; Valencia, Marlie; Sánchez, María Inés Pinto; Serrano, Pablo E.

doi:10.1007/s11605-019-04173-5

Cited by 64 publications

(45 citation statements)

References 81 publications

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“…Some recent studies assessed the effect of preoperative or perioperative immunonutrition on postoperative complications, showing conflicting results. Thus, while a reduction in infectious and non-infectious complications was found in two systematic reviews and meta-analysis [ 18 , 19 ], this protective effect was not found in a large national cohort study [ 21 ]. It should be emphasized that these studies included patients with different gastrointestinal malignancies following surgical procedures of variable extent.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, these immuno-nutrients may enhance protein synthesis after surgery reducing septic and other postoperative complications [ 17 ]. Some studies have shown that the intake of immunonutrition may decrease overall postoperative infectious and non-infectious complications in patients undergoing major oncological surgery [ 18 , 19 ]. However, this benefit has been questioned in some other studies [ 20 , 21 ], and has not been studied so far in patients with peritoneal carcinomatosis following CRS procedures.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Preoperative Immunonutrition on Postoperative Major Morbidity after Cytoreductive Surgery and HIPEC in Patients with Peritoneal Metastasis

et al. 2021

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The effect of preoperative immunonutrition intake on postoperative major complications in patients following cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) was assessed. The accuracy of C-Reactive Protein (CRP) for detecting postoperative complications was also analyzed. Patients treated within a peritoneal carcinomatosis program in which a complete or optimal cytoreduction was achieved were retrospectively analyzed. They were divided into two groups based on whether preoperative immunonutrition (IMN) or not (non-IMN) were administered. Clinical and surgical variables and postoperative complications were gathered. Predictive values of major morbidity of CRP during the first 3 postoperative days (POD) were also evaluated. A total of 107 patients were included, 48 belonging to the IMN group and 59 to the non-IMN group. In multivariate analysis immunonutrition (OR 0.247; 95%CI 0.071–0.859; p = 0.028), and the number of visceral resections (OR 1.947; 95%CI 1.086–3.488; p = 0.025) emerged as independent factors associated with postoperative major morbidity. CRP values above 103 mg/L yielded a negative predictive value of 84%. Preoperative intake of immunonutrition was associated with a decrease of postoperative major morbidity and might be recommended to patients with peritoneal carcinomatosis following CRS. Measuring CRP levels during the 3 first postoperative days is useful to rule out major morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Preoperative Immunonutrition on Postoperative Major Morbidity after Cytoreductive Surgery and HIPEC in Patients with Peritoneal Metastasis

et al. 2021

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“…In this context, immunonutrition is superior, at least in terms of the risk of infectious complications, compared to standard oral nutritional supplements. Focusing on patients undergoing esophagectomy, another recent meta-analysis including six randomized trials of perioperative immunonutrition did not show significant benefits regarding postoperative complication rate [ 11 ]. Thus far, the ESPEN guideline recommends ONS before major operations for 5–7 days, with immunomodulating supplements being preferred [ 7 ].…”

Section: Immunological Conditioningmentioning

confidence: 99%

“…Benefits of supplementation with a glucose drink, increased protein intake, and immunonutrition were shown to reduce postoperative complications (RR 0.74, 95% CI 0.69–0.80), postoperative infections (RR 0.71, 95% CI 0.64–0.79), and non-infectious complications (RR 0.79, 95% CI 0.71–0.87) with a reduction in length of hospital stay of 1.58 days (95% CI −1.83 to −1.32). Nevertheless, there is considerable heterogeneity of the included studies (I = 89%) [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery

Wobith

Weimann

2021

Nutrients

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Nowadays, patients undergoing gastrointestinal surgery are following perioperative treatment in enhanced recovery after surgery (ERAS) protocols. Although oral feeding is supposed not to be stopped perioperatively with respect to ERAS, malnourished patients and inadequate calorie intake are common. Malnutrition, even in overweight or obese patients, is often underestimated. Patients at metabolic risk have to be identified early to confirm the indication for nutritional therapy. The monitoring of nutritional status postoperatively has to be considered in the hospital and after discharge, especially after surgery in the upper gastrointestinal tract, as normal oral food intake is decreased for several months. The article gives an overview of the current concepts of perioperative enteral nutrition in patients undergoing gastrointestinal surgery.

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“…In der Chirurgie haben mangelernährte Patienten ein höheres Risiko für einen ungünstigen postoperativen Verlauf mit erhöhter postoperativer Morbidität und Mortalität [5,6]. In diesem Kontext sind die positiven Effekte einer perioperativen Ernährungstherapie gut belegt, auch wenn die Datengrundlage heterogen ist [7,8].…”

Section: Introductionunclassified

Entwicklung und Implementierung einer ernährungsmedizinischen Strategie zur optimierten Versorgung von Patienten mit Mangelernährung in einem Großklinikum

et al. 2021

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Zusammenfassung Hintergrund Mangelernährung bei hospitalisierten Patienten ist ein relevantes Problem unterschätzten Ausmaßes mit negativen Auswirkungen auf das Überleben und den Behandlungserfolg bei einer Vielzahl von chirurgischen Krankheitsbildern. Zwischen dem in Leitlinien definierten Versorgungsanspruch und der klinischen Realität besteht oftmals eine Diskrepanz. Hauptursache ist die mangelhafte Etablierung ernährungsmedizinischer Strukturen als integraler Bestandteil der Regelversorgung im klinischen Alltag. Die notwendige Weiterentwicklung dieser Strukturen ist durch knappe Ressourcen, aber möglicherweise im Einzelfall auch durch mangelndes Problembewusstsein erschwert, sodass Praxisrelevanz und Machbarkeit im Hinblick auf die örtlichen Gegebenheiten die entscheidenden Kriterien für eine nachhaltige Verbesserung sind. Methoden Dargestellt wird am Beispiel eines Großklinikums, welche institutionellen und prozeduralen Maßnahmen zur Implementierung einer ernährungsmedizinischen Gesamtstrategie durchgeführt werden mussten. Es wird in die zugrunde liegende ernährungsmedizinische Methodik eingeführt sowie anhand von 4 Projekten die konkrete Implementierung im klinischen Alltag veranschaulicht. Ergebnisse Mit der hier vorgestellten Systematik konnten an einem Großklinikum innerhalb eines Jahreszeitraumes die Strukturen geschaffen werden, um Malnutrition im stationären Setting zu erfassen, eine ernährungsmedizinische Komplexbehandlung durchführen zu können und durch fortlaufende und zukünftige Projektinitiativen die Ernährungssituation hospitalisierter Patienten fortlaufend zu verbessern. Zusammenfassung Die hier dargestellte, am Universitätsklinikum Bonn erfolgreich eingeführte ernährungsmedizinische Gesamtstrategie kann als Modellerfahrung für Kliniken dienen, die eine Verbesserung der ernährungsmedizinischen Versorgungslage und damit der Behandlungsqualität bei ihren Patienten erwirken wollen.

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Effect of Perioperative Nutritional Supplementation on Postoperative Complications—Systematic Review and Meta-Analysis

Cited by 64 publications

References 81 publications

Effect of Preoperative Immunonutrition on Postoperative Major Morbidity after Cytoreductive Surgery and HIPEC in Patients with Peritoneal Metastasis

Effect of Preoperative Immunonutrition on Postoperative Major Morbidity after Cytoreductive Surgery and HIPEC in Patients with Peritoneal Metastasis

Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery

Entwicklung und Implementierung einer ernährungsmedizinischen Strategie zur optimierten Versorgung von Patienten mit Mangelernährung in einem Großklinikum

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