The clinical value of parenteral immunonutrition in surgical patients.
OBJECTIVE
To analyze the clinical impact and cost-effectiveness of parenteral immunonutrition (PN).


METHODS
Prospective clinical trial of a group of 105 patients operated on for gastric carcinoma between 2001-2003. During the postoperative period, patients were randomly allocated to one of three groups: standard PN (A), PN + glutamine (B) and PN + omega-3-FA (C). The rate and type of complications, hepatic and renal function, cost and treatment tolerance in all groups were analyzed.


RESULTS
Postoperative complications were observed in 11 patients (36.6%) in group A, in 7 (23.3%) in B and in 8 (26.6%) in C. The most common complication was pneumonia. Prealbumin concentration and TLC increased faster in groups B and C. The length of hospital stay was significantly shorter in the immunonutrition groups. The cost of PN was highest in C group, while cost of hospital stay was longer in A.


CONCLUSIONS
Immunostimulating parenteral nutrition helps to reduce the number of infectious complications, improves the function of the immune system, and has no influence on surgical complications, hepatic and renal function and protein synthesis. The cost of immunostimulating treatment based on omega-3-unsaturated fatty acids is higher than standard.
Kłek
S
S
1st Department of General and GI Surgery, Collegium Medicum Jagiellonian University, Cracow, Poland. sklek@mp.pl
Kulig
J
J
Szczepanik
A M
AM
Jedrys
J
J
Kołodziejczyk
P
P
D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D019587:Dietary Supplements; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D005973:Glutamine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000628:therapy*; D009751:Nutritional Requirements; D010288:Parenteral Nutrition / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D015525:Fatty Acids, Omega-3; D005973:Glutamine