Preoperative administration of an immune-enhancing oral supplement helps patients to fight off infections after operations, and spend less time in hospital, concludes a study presented recently.
The study examined the benefit of Impact, an enteral immune-enhancing drink made by Novartis Clinical Nutrition, which is supplemented with arginine, omega-3 polyunsaturated fatty acids and ribonucleotides.
Presenting the study at a meeting of the Surgical Infection Society Europe last month, Dr Luca Gianotti from the Department of Surgery at the University of Milano-Bicocca, Monza, Italy, explained that surgical trauma increases levels of proinflammatory cytokines and lowers host defense mechanisms.
Dr Gianotti conducted two trials in patients with gastrointestinal cancer comparing preoperative treatment and perioperative treatment with a control group who received no additional immune-enhancing supplementation to normal diet. One trial enrolled 150 malnourished patients, the other enrolled 305 well-nourished patients.
The published results showed that in malnourished patients (those who had lost more than 10 per cent of body weight in the previous six months) patients in the control group had significantly more postoperative complications than those treated preoperatively, while those treated before and after surgery even fewer. This was reflected in patients' total length of hospital stay, which was significantly shorter in the preoperative (13.2 days) and perioperative (12.0 days) groups than in the control group (15.3 days).
But in well-nourished patients, oral preoperative supplementation showed similar results to perioperative immune-enhancing supplementation, and both were superior to the control approach, said the researcher. Incidence of postoperative infections was 14 per cent in the preoperative group and 16 per cent in the perioperative group, but over 30 per cent in the control group.
Dr Gianotti explained: "Preoperative feeding five days prior to surgery modulates the host immune defense mechanisms sufficiently to avoid surgical depression of the immune system, and thus to fight off postoperative infections."
"Whether patients are malnourished or well-nourished, preoperative supplementation with an immune-enhancing formula will ensure that patients are fit for surgery," he said. "But in well-nourished patients we can avoid possible side-effects of enteral feeding, such as nasojejunal tube clogging or removal, abdominal cramps and save the costs of providing postoperative immunonutrition."
He added that the supplementation also produced cost savings on postoperative complications. For patients with complications the cost per patient was lowest in the preoperative treatment group.
"The major cost of surgical complications, particularly infectious complications, is the cost of prolonged hospital stays," said Dr Gianotti. "The benefit of immunonutrition is mainly in reducing the rate of infectious complications. The cost of providing a preoperative immune-enhancing diet was more than offset by the reduced length of stay from this approach."