title: Preoperative immunonutrition in patients at nutritional risk: results of a double-blinded randomized clinical trial.
abstract: OBJECTIVE
  To evaluate the impact of preoperative immunonutrition (IN) on postoperative morbidity in patients at risk of malnutrition undergoing major gastrointestinal (GI) surgery.
  
  
  METHODS
  The combination of malnutrition and major GI surgery entails high morbidity. The Nutritional Risk Score (NRS) reliably identifies patients who need preoperative nutrition; the optimal nutritional formula for these patients still needs to be defined. In all, 152 patients with a NRS≥3 and undergoing elective major GI surgery were randomized between IN or isocaloric-isonitrogenous nutrition (ICN) given for 5 days preoperatively. Patients and caregivers were blinded for the allocated intervention. Thirty days complication rate was the primary endpoint. Infections, length of hospital stay and compliance were considered as secondary outcomes.
  
  
  RESULTS
  Overall, 145 patients were available for analysis; the 73 patients in the IN group matched well with the 72 ICN patients with regards to patient's and surgical characteristics. In all, 39 IN and 33 ICN patients experienced a total of 48 and 50 postoperative complications, respectively (P=0.723). Both groups did not differ significantly concerning infectious (13 vs 9) complications. Independent risk factors for overall complications were malignant disease (odds ratio (OR)=4.304; confidence interval (CI) 1.317-14.002) and operative time (OR=1.004; CI 1.000-1.008).
  
  
  CONCLUSIONS
  In patients at nutritional risk, complications, infections and hospital stay after major GI surgery were comparable regardless of preoperative supplementation with IN or ICN.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Hübner
authors.forename: Y
authors.initials: Y
authors.lastname: Cerantola
authors.forename: F
authors.initials: F
authors.lastname: Grass
authors.forename: P C
authors.initials: PC
authors.lastname: Bertrand
authors.forename: M
authors.initials: M
authors.lastname: Schäfer
authors.forename: N
authors.initials: N
authors.lastname: Demartines
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003428:Cross Infection; D004032:Diet; D004311:Double-Blind Method; D017558:Elective Surgical Procedures / Q000009:adverse effects; D004750:Enteral Nutrition; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000276:immunology / Q000517:prevention & control*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors