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

Barker, Lisa A.; Gray, C. M.; Wilson, Lisa M; Thomson, Benjamin; Shedda, Susan; Crowe, Timothy C.

doi:10.1038/ejcn.2013.117

Cited by 47 publications

(33 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Five hundred and sixty-one patients in 8 RCTs 9-16 of preoperative IN vs ONS were identified (Table 1) and 895 patients in 9 RCTs of IN vs no supplements were also identified ( Table 2). 11,14,[17][18][19][20][21][22][23] Preoperative immunonutrition vs standard oral nutritional supplements When compared with ONS, preoperative IN was not associated with a reduced rate of wound infection (OR ¼ 0.97; 95% CI, 0.45e2.11; p ¼ 0.94), all infectious complications (OR ¼ 0.71; 95% CI, 0.30e1.68; p ¼ 0.44), noninfectious complications (OR ¼ 1.25; (Fig. 3).…”

Section: Resultsmentioning

confidence: 78%

See 1 more Smart Citation

Preoperative Standard Oral Nutrition Supplements vs Immunonutrition: Results of a Systematic Review and Meta-Analysis

Hegazi

Hustead

Evans

2014

Journal of the American College of Surgeons

114

View full text Add to dashboard Cite

Multiple studies and meta-analyses have suggested some benefit to immunonutrition (IN) supplements. These studies have often included pre-and post-operative regimens and have utilized inconsistent controls ranging from standard non-supplemented oral diets to high-quality isonitrogenous controls. This study aims to compare outcomes after preoperative nutritional supplementation with IN vs. standard oral nutritional supplements (ONS) or a regular diet without supplements.We performed a systematic literature review. 8 randomized controlled trials (RCTs) of preoperative IN vs. ONS were identified and 9 RCTs of IN vs. no supplements were also identified. Meta-analysis was performed for reported outcomes including wound infection, infectious and non-infectious complications, and length of stay (LOS). The meta-analysis was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations.We identified 561 patients in 8 RCTs of preoperative IN vs. ONS. 895 patients were identified in 9 RCTs of IN vs. no supplements. When compared to ONS, preoperative IN was not associated with reduced wound infection (OR 0.97, 95% Confidence Interval (CI) 0.45 to 2.11), all infectious complications (OR 0.71, 95% CI 0.30 to 1.68), non-infectious complications (OR 1.25, 95% CI 0.64 to 2.43), or LOS (mean difference 0.07 days, 95% CI À2.29 to 2.43). In RCTs controlled with non-supplemented standard diets, preoperative IN was associated with decreased infectious complications (OR 0.49, 95% CI 0.30 to 0.83, p 0.01) and LOS (mean difference À2.22 days, 95% CI À2.99 to À1.45, p 0.01).In conclusion, there was no evidence for IN to be superior to ONS on several key clinical outcomes. Therefore standard ONS may offer an alternative to IN for preoperative nutritional supplementation.

show abstract

Section: Resultsmentioning

confidence: 78%

“…38 Recently, 4 small trials of preoperative IN have not shown any benefit. 15,16,21,22 Including some but not all of the new trials, Osland and colleagues recently published their own meta-analysis. 3 Like the others, their metaanalysis combined all trials examining preoperative supplementation regardless of the type of control used.…”

Section: Discussionmentioning

confidence: 97%

Preoperative Standard Oral Nutrition Supplements vs Immunonutrition: Results of a Systematic Review and Meta-Analysis

Hegazi

Hustead

Evans

2014

Journal of the American College of Surgeons

114

View full text Add to dashboard Cite

show abstract

“…Further, some later small randomized trials of IMN did not show benefit compared to isonitrogenous formulas. [79][80][81] Two studies of perioperative IMN have occurred in the context of ERP and have suggested benefit. The larger was a RCT of 264 patients that demonstrated a reduction in infectious complications (23.8% vs 10.7%; P = .0007), particularly wound infections (16.4% vs 5.7%; P = .0008) with the use of IMN when compared to standard high-calorie supplements.…”

Section: Role Of Perioperative Imnmentioning

confidence: 99%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Wischmeyer

Carli

Evans

et al. 2018

Anesthesia &Amp; Analgesia

335

327

View full text Add to dashboard Cite

Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.

show abstract

“…Furthermore, surgery in malnourished and immuno-compromised patients is associated with many adverse outcomes, including infection, impaired wound healing, increased length of stay and increased risk of mortality. 38 Thus, it may often be in the patient's best interests to surgically intervene early if there is a risk that conservative therapy may fail or be prolonged.…”

Section: Discussionmentioning

confidence: 99%

Nutritional management in patients with chyle leakage: a systematic review

Steven

Carey

2015

Eur J Clin Nutr

View full text Add to dashboard Cite

show abstract

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

Abstract: 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.

Cited by 47 publications

References 36 publications

Preoperative Standard Oral Nutrition Supplements vs Immunonutrition: Results of a Systematic Review and Meta-Analysis

Preoperative Standard Oral Nutrition Supplements vs Immunonutrition: Results of a Systematic Review and Meta-Analysis

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Nutritional management in patients with chyle leakage: a systematic review

Contact Info

Product

Resources

About