title: Post-operative enteral immunonutrition for gynecologic oncology patients undergoing laparotomy decreases wound complications.
abstract: OBJECTIVE
  The aim of this study is to determine if peri-operative immune modulating dietary supplements decrease wound complications in gynecologic oncology patients undergoing laparotomy.
  
  
  METHODS
  In July 2013 we instituted a practice change and recommended pre- and post-operative oral immune modulating diets (IMDs) to patients undergoing laparotomy. We retrospectively compared patients who received IMDs to those who did not for the study period July 2012 to June 2014. Our outcome of interest was the frequency of Centers for Disease Control surgical site infections (CDC SSIs).
  
  
  RESULTS
  Of the 338 patients who underwent laparotomy during the study period, 112 (33%) received IMDs post-operatively. There were 89 (26%) wound complications, including 69 (78%) CDC SSI class 1, 7(8%) class 2 and 13(15%) class 3. Patients receiving IMDs had fewer wound complications than those who did not (19.6% vs. 33%, p=0.049). After controlling for variables significantly associated with the development of a wound complication (ASA classification, body mass index (BMI), history of diabetes mellitus or pelvic radiation, length of surgery and blood loss) consumption of IMDs remained protective against wound complications (OR 0.45, CI 0.25-0.84, p=0.013) and was associated with a 78% reduction in the incidence of CDC SSI class 2 and 3 infections (OR=0.22, CI 0.05-0.95, p=0.044).
  
  
  CONCLUSIONS
  Post-operative IMDs are associated with fewer wound complications in patients undergoing laparotomy for gynecologic malignancy and may reduce the incidence of CDC SSI class 2 and 3 infections.
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, United States; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, United States.
authors.forename: J S
authors.initials: JS
authors.lastname: Chapman
authors.affiliation: School of Medicine, University of California San Francisco, United States.
authors.forename: E
authors.initials: E
authors.lastname: Roddy
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, United States; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, United States.
authors.forename: G
authors.initials: G
authors.lastname: Westhoff
authors.affiliation: Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Utah, United States.
authors.forename: E
authors.initials: E
authors.lastname: Simons
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, United States; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, United States.
authors.forename: R
authors.initials: R
authors.lastname: Brooks
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, United States; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, United States.
authors.forename: S
authors.initials: S
authors.lastname: Ueda
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, United States; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, United States. Electronic address: Lee-may.chen@ucsfmedctr.org.
authors.forename: L
authors.initials: L
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complications; Immune-modulating diets; Malnutrition; Post-operative; Surgical site infections