Postsurgical Infections are Reduced with Specialized Nutrition Support

Waitzberg, Dan Linetzky; Saito, Hideaki; Plank, Lindsay D.; Jamieson, Glyn G.; Jagannath, P.; Hwang, Tsann‐Long; Mijares, J. M.; Bihari, David

doi:10.1007/s00268-005-0657-x

Cited by 245 publications

(215 citation statements)

References 55 publications

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“…Details on timing, duration, route of administration and product vary depending on patient-and procedure-related risk factors and from the respective societies (ASPEN guidelines, 2002;Mariette et al, 2005;Weimann et al, 2006;Stratton and Elia, 2007). Acceptance of nutrition in surgery F Grass et al Several meta-analyses and systematic reviews analysing the use of different nutritional formula have been recently published (Waitzberg et al, 2006;Weimann et al, 2006;Stratton and Elia, 2007;Jones and Heyland, 2008;Cerantola et al, 2011). Despite some disparities exist, it is now generally accepted that perioperative nutrition is beneficial for patients undergoing major GI surgery by reducing overall complication rates, postoperative infectious complications and length of hospital stay (Waitzberg et al, 2006;Weimann et al, 2006;Stratton and Elia, 2007;Jones and Heyland, 2008;Sorensen et al, 2008).…”

Section: Nutritional Screeningmentioning

confidence: 99%

“…Acceptance of nutrition in surgery F Grass et al Several meta-analyses and systematic reviews analysing the use of different nutritional formula have been recently published (Waitzberg et al, 2006;Weimann et al, 2006;Stratton and Elia, 2007;Jones and Heyland, 2008;Cerantola et al, 2011). Despite some disparities exist, it is now generally accepted that perioperative nutrition is beneficial for patients undergoing major GI surgery by reducing overall complication rates, postoperative infectious complications and length of hospital stay (Waitzberg et al, 2006;Weimann et al, 2006;Stratton and Elia, 2007;Jones and Heyland, 2008;Sorensen et al, 2008). Immunonutrition, containing arginine, ribonucleic acid and n-3 fatty acids should be preferred as standard nutritional formula in patients undergoing GI cancer surgery (Waitzberg et al, 2006;Weimann et al, 2006;Xu et al, 2006;Bozzetti et al, 2007;Cerantola et al, 2011).…”

Section: Nutritional Screeningmentioning

confidence: 99%

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Perioperative nutrition is still a surgical orphan: results of a Swiss–Austrian survey

et al. 2011

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Background/Objectives: There is strong evidence for the beneficial effects of perioperative nutrition in patients undergoing major surgery. We aimed to evaluate implementation of current guidelines in Switzerland and Austria. Subjects/Methods: A survey was conducted in 173 Swiss and Austrian surgical departments. We inquired about nutritional screening, perioperative nutrition and estimated clinical significance. Results: The overall response rate was 55%, having 69% (54/78) responders in Switzerland and 44% (42/95) in Austria. Most centres were aware of reduced complications (80%) and shorter hospital stay (59%). However, only 20% of them implemented routine nutritional screening. Non-compliance was because of financial (49%) and logistic restrictions (33%). Screening was mainly performed in the outpatient's clinic (52%) or during admission (54%). The nutritional risk score was applied by 14% only; instead, various clinical (78%) and laboratory parameters (56%) were used. Indication for perioperative nutrition was based on preoperative screening in 49%. Although 23% used preoperative nutrition, 68% applied nutritional support pre-and postoperatively. Preoperative nutritional treatment ranged from 3 days (33%), to 5 (31%) and even 7 days (20%). Conclusions: Although malnutrition is a well-recognised risk factor for poor post-operative outcome, surgeons remain reluctant to implement routine screening and nutritional support according to evidence-based guidelines.

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Section: Nutritional Screeningmentioning

confidence: 99%

Section: Nutritional Screeningmentioning

confidence: 99%

Perioperative nutrition is still a surgical orphan: results of a Swiss–Austrian survey

et al. 2011

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“…Nesta linha de raciocínio, alguns autores estão buscando limitar o foco da amostra. Por exemplo, Waitzberg et al 40 , em 2006, apresentou estudo em que incluiu apenas pacientes cirúrgicos no pré-operatório, apesar de utilizar produto com diversos imunonutrientes. Conseguiu na metanálise definir a dose a ser utilizada (0,5 a 1L/dia) de uma dieta comercial, assim como a duração da suplementação (cinco a sete dias antes do procedimento operatório).…”

Section: Discussionunclassified

“…Em recente metanálise incluindo 18 estudos prospectivos e randomizados, foi detectada redução das deiscências de anastomoses 40 . Entretanto, como os suplementos nutricionais incluem outras substâncias além da arginina, não foi possível definir especificamente qual substância seria responsável pelo efeito obtido.…”

Section: Abcddv/631unclassified

Efeito da suplementação dietética de arginina na cicatrização das anastomoses colônicas em ratos

Corrêa-Neto¹,

Campos²,

Branco³

et al. 2009

ABCD, arq. bras. cir. dig.

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InTRODUÇÃOCicatrização adequada é considerada fundamental para o sucesso de qualquer intervenção cirúrgica, e uma falha neste processo pode levar à deiscências das suturas e graves consequências. A medida em que o processo fisiológico da cicatrização tornou-se progressivamente compreendido, fatores que influenciam este processo foram sendo descobertos e avaliados.Falhas nas anastomoses intestinais resultam em deiscências e fístulas, associadas a alta morbi-mortalidade. Já foram bem identificadas causas locais e sistêmicas que aumentam os riscos de deiscências anstomóticas. Os principais fatores locais são a realização de anastomoses sem tensão, com boa vascularização, ausência de infecção, boa coaptação dos bordos da ferida e inclusão da submucosa nos pontos, por ser esta camada rica em colágeno 9,14 .Além dos locais, a influência de fatores sistêmicos sobre o processo é relevante. A presença de desnutrição, o uso de anti-inflamatórios hormonais e não-hormonais e de anti-neoplásicos e a radiação ionizante influenciam negativamente a cicatrização das anastomoses, enquanto o uso judicioso de nutrição perioperatória, especialmente com dietas imunomoduladoras ou suplementos dietéticos podem aumentar a resistência tênsil das anastomoses 3,5,8,33,39 .Em face à dificuldade em estudar tais mecanismos de ação em condições clínicas, alguns modelos de experimentação foram sendo desenvolvidos. A arginina, aminoácido semi-essencial, possui papel fundamental no metabolismo de diversos componentes do organismo humano 36 . Possui ação importante como substrato na síntese protéica, proliferação celular, neurotransmissão, vasodilatação, imunidade e no processo de cicatrização. É precursora do óxido nítrico, creatina fosfato, uréia, ornitina, prolina e outras moléculas. Como precursora da prolina possui papel importante na síntese da hidroxiprolina e, consequentemente, do colágeno. Em situações de estresse sua demanda aumenta e ela se torna aminoácido condicio- ABCDDV/631Corrêa-Neto MP, Campos ACL, Branco AB, Matias JEF. Efeito da suplementação dietética de arginina na cicatrização das anastomoses colônicas em ratos. ABCD Arq Bras Cir Dig 2009;22(1):7-14 RESUMO -Racional -A arginina, aminoácido condicionalmente essencial, participa de diversos processos fisiológicos, em particular na cicatrização e na função imune. Objetivo -Avaliar o efeito da suplementação por via oral da arginina na cicatrização colônica em ratos. Método -Foram utilizados 47 ratos Wistar machos, adultos, com peso médio de 345,45 ± 8,35g, alocados em gaiolas coletivas em grupos cinco ou seis animais. Todos receberam água e ração ad libitum, pesados a cada dois dias e randomizados para receberem por gavagem suplementação com arginina a 10% (grupo ARG) ou solução de aminoácidos a 10% (grupo AA) de forma isovolumétrica, isocalórica e isonitrogenada (1,5 g/kg/dia) por sete dias antes do procedimento operatório e quatro após. Um terceiro grupo recebeu solução salina isotônica (grupo SSI), isovolumetricamente. Os ratos foram submetidos a duas colônicas término-termin...

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“…Immune-enhancing v. standard enteral nutrition Several reviews and meta-analyses have been published on this topic (31)(32)(33)(34) . The most recent and complete was published by Cerantola et al in 2001 (35) .…”

Section: Comparing Parenteral With Enteral Nutritionmentioning

confidence: 99%

Peri-operative nutritional management

Bozzetti

2011

Proc. Nutr. Soc.

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The metabolic response to surgical trauma is mainly characterised by an increase in BMR, a negative N balance, increased gluconeogenesis and increased synthesis of acute-phase proteins. These reactions aim at ensuring the availability of endogenous substrates for healing wounds while the synthesis of acute-phase proteins enhances the scavenging process and helps repair. However, if this process is excessive or continues for too long, it leads to a progressive depletion of body compartment with a consequent adverse outcome. Obviously, the severity of such depletion is magnified if the patient is starving or is already malnourished and the consumption of lean body mass is not compensated by an exogenous supply of nutrients. The nutritional control of this metabolic reaction represents the traditional rationale for nutritional support of surgical patients. Subsequent data have shown that the negative effects of starvation are not simply due to the starvation per se but due to the starving gut, and peri-operative enteral nutrition has proven successful in blunting the metabolic response after injury and improving protein kinetics, net balance and amino acid flux across peripheral tissue and consequently in decreasing the complications. Finally, further clinical research has shown that many postoperative infections may result from immune suppression and that such state might be reversed to some degree by modulation of the immune response through specialised nutritional support in surgical patients, regardless of their nutritional status. This paper will focus on the updated evidence-based research on peri-operative nutrition (parenteral, enteral and immune-enhancing) in patients undergoing major surgery. Peri-operative parenteral nutrition: Peri-operative enteral nutrition: Peri-operative immunonutritionThe metabolic response to surgical trauma is mainly characterised by an increase in BMR, a negative N balance, increased gluconeogenesis and increased synthesis of acute-phase proteins. These reactions aim at ensuring the availability of endogenous substrates for healing wounds while the synthesis of acute-phase proteins enhances the scavenging process and helps repair. However, if this process is excessive or continues for too long, it leads to a progressive depletion of body compartments with a consequent adverse outcome. Obviously, the severity of such depletion is magnified if the patient is starving or is already malnourished and the consumption of lean body mass is not compensated by an exogenous supply of nutrients.The nutritional control of this metabolic reaction has represented the traditional rationale for nutritional support of surgical patients because it is understood that severe weight loss ( ‡ 10% of the usual body weight) is associated with an increased risk of surgical complications (1) . This increased risk of complications due to the presence of malnutrition (evaluated as severity of the weight loss or with the use of more complex scores including anthropometric, biologic or immunologic parameters)...

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Postsurgical Infections are Reduced with Specialized Nutrition Support

Cited by 245 publications

References 55 publications

Perioperative nutrition is still a surgical orphan: results of a Swiss–Austrian survey

Perioperative nutrition is still a surgical orphan: results of a Swiss–Austrian survey

Efeito da suplementação dietética de arginina na cicatrização das anastomoses colônicas em ratos

Peri-operative nutritional management

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