Outcome and Cost-effectiveness of Perioperative Enteral Immunonutrition in Patients Undergoing Elective Upper Gastrointestinal Tract Surgery

Senkal, M.; Zumtobel, V.; Bauer, Karl-Heinz; Marpe, Barbara; Wolfram, G.; Frei, Andreas; Eickhoff, Ulrich; Kemen, M.

doi:10.1001/archsurg.134.12.1309

Cited by 266 publications

(187 citation statements)

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“…We wanted to minimize the use of tubes because they may disturb mobilization and the overall recovery of patients. our total and infectious complications rates were well comparable with previous studies in immunonutrition group, and in conventional group the rates werelittle lower than in the other studies (12,20,23,24). therew as no difference in any complications rates between the groups.…”

Section: Discussionsupporting

confidence: 89%

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Immunonutrition in Elective Gastrointestinal Surgery Patients

2007

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Background: previous trials have shown that perioperative immunonutrition could protect patients from infectious complications after gastrointestinal cancer operations. the purpose of this study was to determine whether perioperative immunonutrition decreases postoperative morbidity,especially infection complications, mortality and length of hospital stay in patients undergoing major gastrointestinal tract surgery.Methods: one hundred patients with ap lanned elective operation for benign or malignant gastrointestinal illness were randomized into two groups: group 1) oral supplementation for five days before and five days after surgery with 900 mL/day of aformula enriched with arginine, gamma-3-fatty acid and rna +liquid diet ad libitum on one and two postoperative day and then solid food (immunonutrition group; n=50) or group 2) no artificial nutrition before and after surgery,onone and two postoperativeday intravenous solution of 5% glucoseand electrolytes and then normal diet (conventional group; n=50).Results: the groups were comparable for all key baseline and surgical characteristics. there were nine (18%) infectious complications in both groups. overall complication rates were 28% (n =14) in the immunonutrition group and 24% (n =12) in the conventional group. No significant difference between the groups was found in complication rates, mortality or length of hospital stay.Conclusion: routine perioperative immunonutrition to the patients undergoing major gastrointestinal surgery is not beneficial.

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Section: Discussionsupporting

confidence: 89%

“…Infections area big problem after majora bdominal surgical procedures, contributing to increased morbidity, mortality and healthcarecosts. During the last 15 years, enteral immunonutrition has been shown to improve outcome in major abdominalcancer surgery (18)(19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Immunonutrition in Elective Gastrointestinal Surgery Patients

2007

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“…Pooled results from the studies in abdominal and orthopaedic surgery, as well as in elderly patients revealed net cost savings per patient both in terms of inpatient stay and complications (Russell, 2007). Enteral and oral immunonutrition has also been associated with reduced postoperative complication rates and, thus substantially reduced treatment costs in patients undergoing major abdominal surgery (Senkal et al, 1999) or cancer surgery (Gianotti et al, 2000;Braga and Gianotti, 2005), despite higher costs of the product. In nursing homes, offering snacks has been shown to be associated with greater cost-effectiveness than intervention with ONS (Simmons et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of a 3-month intervention with oral nutritional supplements in disease-related malnutrition: a randomised controlled pilot study

et al. 2011

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Background/Objectives: Nutritional intervention with oral nutritional supplements (ONS) has been shown to increase quality of life in malnourished patients. We investigated whether post-hospital supplementation with ONS is cost-effective according to international benchmarks in malnourished patients. Subjects/Methods: In total, 114 malnourished patients (50.6±16.1 years, 57 female) with benign gastrointestinal disease were included and randomised to receive either ONS for 3 months and dietary counselling at discharge (intervention, n ¼ 60) or only dietary counselling at discharge (control group, n ¼ 54). Nutritional status was assessed with Subjective Global Assessment. Intervention patients documented daily intake of ONS; quality of life was assessed with Short-Form (SF)-36 Health Survey and SF-36 values were transformed into health-status utilities. Quality-adjusted life years (QALYs) were calculated by adopting the area under the curve method. We used two different pricing scenarios for ONS (minimum price: h2.30 and maximum: h2.93/ tetrapack). The incremental cost-effectiveness ratio (ICER) of supplementation with ONS was calculated for both price scenarios. All analyses were corrected for age and gender. Results: Intervention patients consumed 2.4 ± 0.8 ONS per day. Intervention and control patients did not differ in their health status utilities at baseline (0.594 ± 0.017 vs 0.619 ± 0.018), but after 3 months, the health status utilities were significantly higher in intervention patients than in control patients (0.731 ± 0.015 vs 0.671 ± 0.016, P ¼ 0.028). Intervention was associated with significantly higher costs (ICER: h9497 and h12 099/additional QALY, respectively) but deemed cost-effective according to international thresholds (oh50 000/QALY). Conclusions: A 3-month intervention with ONS increases quality of life in malnourished patients. This treatment appears to be cost-effective according to international benchmarks.

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“…Certain nutrients such as glutamine, arginine, and ω-3 fatty acids as well as nucleotides, may act pharmacologically on the immune system. It has been suggested that these nutrients may improve host immune defences [13][14][15][16] . Our data show that plasma glutamine and arginine levels were decreased 1d after operation in both groups.…”

mentioning

confidence: 99%