Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study.
OBJECTIVE
Perioperatively administered enteral immunonutrition will improve early postoperative morbidity and cost-effectiveness after gastrointestinal tract surgery.


METHODS
A prospective, randomized, double-blind, multicenter clinical trial.


METHODS
Surgical departments in German university and teaching hospitals.


METHODS
One hundred fifty-four patients with upper gastrointestinal tract malignant neoplasms who were eligible for analysis.


METHODS
Preoperatively, patients received 5 days of oral immunonutrition (an arginine-, RNA-, and omega3 fatty acid-supplemented diet) or an isoenergetic control diet (1 L/d). Early postoperative enteral feeding with immunonutrition or an isoenergetic, isonitrogenous control diet using a catheter jejunostomy was performed for 10 days.


METHODS
Postoperative infectious complications, their treatment costs, and cost-effectiveness of immunonutrition were analyzed. Plasma levels of the fatty acids eicosapentaenoic acid and docosahexaenoic acid were measured.


RESULTS
In the immunonutrition group, significantly fewer infectious complication events occurred (14 vs 27; P = .05). The number of patients with complications was significantly lower in the supplemented diet group after postoperative day 3 (7 vs 16; P = .04). The treatment costs of complications in the supplemented diet group were suggestively lower than in the control diet group (DM 75172 vs DM 204273). Cost-effectiveness was DM 1503 in the experimental group vs DM 3587 in the control group, where DM denotes deutsche mark (German currency).


CONCLUSIONS
The perioperative administration of an enteral immunonutrition significantly (P = .05) decreased the early occurrence of postoperative infections and reduced substantially the treatment costs of the complications after major upper gastrointestinal tract surgery.
Senkal
M
M
Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Germany.
Zumtobel
V
V
Bauer
K H
KH
Marpe
B
B
Wolfram
G
G
Frei
A
A
Eickhoff
U
U
Kemen
M
M
D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000368:Aged; D004281:Docosahexaenoic Acids / Q000097:blood; D004311:Double-Blind Method; D015118:Eicosapentaenoic Acid / Q000097:blood; D004750:Enteral Nutrition / Q000191:economics*; D015525:Fatty Acids, Omega-3 / Q000097:blood; D005260:Female; D005526:Food, Formulated; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies
D000276:Adjuvants, Immunologic; D015525:Fatty Acids, Omega-3; D004281:Docosahexaenoic Acids; D015118:Eicosapentaenoic Acid