[Treatment of mild malnutrition and reduction of morbidity in major abdominal surgery: randomized trial on 153 patients].
OBJECTIVE
Severe malnutrition (defined as weight loss more than 10% in a period of six months) is considered an important risk factor in major abdominal surgery, because of a higher post-operative mortality and morbidity. The aim of our study is to assess the role of mild malnutrition (weight loss low than 10% in a period of six months) as a risk factor in major abdominal surgery and to evaluate the efficacy of therapy in order to improve outcomes in terms of in-hospital mortality, length of hospital stay and post-operative complications. Moreover, we evaluated serum albuminemia and lymphocyte count, important nutritional index, as predictive risk factors.


METHODS
We performed a randomized prospective trial, and admitted in our institution 153 adult patients, 43 with mild malnutrition and 110 without. The malnourished patients were randomized in two groups: the first one received oral immunonutrition (Impact Oral) for 7-10 days before surgery (22 pz), the second one received no nutritional support.


RESULTS
We observed a higher number of complications in the non-treated malnourished patients (57%) versus both the treated malnourished patients (13.6%) and the normal group (19%) (p<0.001). Increased morbidity was observed in patients with serum albuminemia <2.8 gr/dl (69.2%) and with lymphocyte count <1.500 mm3 (57%).


CONCLUSIONS
Nutritional enriched support demonstrated his efficacy in reducing morbidity, and length of hospital stay. Pre-operative oral immunonutrition might be suggested and established in all the patients with mild malnutrition that will be operated on major abdominal surgery.
Pronio
A
A
Cattedra di Chirurgia Generale, Policlinico Umberto I, Università La Sapienza, Roma, Italia. annamaria.pronio@uniroma1.it
Di Filippo
A
A
Aguzzi
D
D
Laviano
A
A
Narilli
P
P
Piroli
S
S
Vestri
A
A
Montesani
C
C
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004066:Digestive System Diseases / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D052776:Female Urogenital Diseases / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D052801:Male Urogenital Diseases / Q000601:surgery; D044342:Malnutrition / Q000178:diet therapy* / Q000209:etiology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D012384:Rome; D016019:Survival Analysis; D016896:Treatment Outcome