Perioperative Immunonutrition in Elderly Patients Undergoing Total Hip and Knee Arthroplasty: Impact on Postoperative Outcomes

Abstract

Background: Arthroplasties in elderly patients are surgeries performed to ensure their quality of life. Perioperative care with specific nutrients can improve nutrition status and metabolic response to orthopedic surgeries, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods: Retrospective study with elderly patients divided into 2 groups: control and immunonutrition. The immunonutrition group was instructed to start oral intake of the nutrition supplement 5 days before and to resume it 5 days after arthroplasty (200 mL, 3 times per day). The following were analyzed as primary and secondary outcomes: length of stay (LOS), infectious and noninfectious complications, need for intensive care unit (ICU), transfusion requirement, and C-reactive protein. Results: A total of 3015 elderly patients met the inclusion criteria: control group (n = 1398) and immunonutrition group (n = 1617). Overall, 81.2% were women and mean age was 72.6 ± 6.9 years. Immunonutrition group had a shorter LOS in hours (32.0 ± 19.4 vs 56.0 ± 26.4; P < .001) and lower rates of infectious complications (2.2% vs 4.6%; P < .001). Noninfectious complications and need for ICU also had lower rates in the immunonutrition group. In the logistic regression analysis, immunonutrition reduced the chance of infectious complications by 55% (odds ratio [OR], 0.45; 95% CI, 0.30-0.68; P < .001) even after adjusting for variables (OR, 0.45; 95% CI, 0.28-0.71; P < .001). Conclusion: Perioperative immunonutrition in elderly patients undergoing THA or TKA may shorten postoperative LOS and reduce infectious and noninfectious complications and transfusion requirement.

Dose Selection of Ropivacaine for Spinal Anesthesia in Elderly Patients with Hip Fracture: An Up-Down Sequential Allocation Study

“…It is worth noting that in stage II, when dose selection was guided by the calculation formula, the number of patients admitted to the ICU was 0, while the literature reported that the ICU transfer rate was about 7% in the elderly after surgery for hip fracture under general anesthesia. 28 Given that the median age of patients in this study was as high as 80 years, the prognostic advantage of reducing the rate of ICU admission may have been greater than expected. In addition to the above, there are some peculiarities in this study in terms of the trial protocol.…”

Team Approach: Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty

“…It is also important to note that optimizing patients preoperatively may require a lower threshold to designate nutritional risk given the stressful nature of surgical intervention. Indeed, several investigations have suggested that perioperative nutritional supplementation, even for patients not at risk, is associated with reduced muscle atrophy and accelerated return of functional mobility post-TJA 12,[44][45][46][47][48] (Table V).…”

“…Most preoperative nutritional supplements are taken orally, as patients unable to tolerate oral intake would be considered at high risk for malnutrition on the basis of screening and would not be appropriate candidates for TJA. Notably, in the literature, most studies providing interventional recommendations were limited in that differences in patients' baseline nutritional status were not delineated among the cohorts utilized 12,[44][45][46][47][48] . However, such investigations provide insight into the value of universal perioperative nutritional supplementation given the reported benefits, including reduced LOS, mitigated weakness, improved functional levels, and more favorable metabolic profiles 4,12 .…”

Effects of Preoperative Oral Electrolyte‐Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

“…It is worth noting that patients undergoing TKA were primarily geriatric. An investigation showed that more than 80% of patients were 65 years or older 3 . Along with the accelerated aging population, the prevalence of TKA in the elderly is expected to increase.…”