title: Multimodal perioperative care plus immunonutrition versus traditional care in total hip arthroplasty: a randomized pilot study.
abstract: BACKGROUND
  Multimodal protocols of perioperative care may enhance postoperative recovery. However, limited information is available on preoperative immune and carbohydrate (CHO)-enriched drinks in patients undergoing hip arthroplasty. We aimed to investigate the effect of a multimodal protocol (ACERTO protocol) plus preoperative immune nutrition on the length of stay (LOS) and the postoperative acute phase response of patients undergoing total hip arthroplasty.
  
  
  METHODS
  Thirty-two patients (mean age, 58 years; range, 26-85 years; 16 males) were randomized to receive either the ACERTO protocol (n = 15, ACERTO Group), which consisted of 6 h preoperative fasting for solids, an oral drink (200 mL of 12.5 % maltodextrin) up to 2 h before induction of anesthesia, restricted intravenous fluids (only 1000 mL of crystalloid fluid after surgery) and preoperative immune nutrition (600 mL/day of Impact - Nestlé, Brazil) for five days prior to surgery, or traditional care (n = 17; control group), which consisted of 6-8 h preoperative fasting, intravenous hydration until the 1(st) postoperative day and no preoperative immune supplementation. The main endpoint was LOS. C-reactive protein (CRP) was the secondary endpoint and was assessed during induction of anesthesia and on postoperative day 2.
  
  
  RESULTS
  Neither deaths nor postoperative complications occurred. The median LOS was 3 (2-5) days in the ACERTO group and 6 (3-8) days in controls (P <0.01). Postoperative CRP was higher in the control group (P <0.01).
  
  
  CONCLUSIONS
  The ACERTO multimodal protocol of perioperative care plus preoperative immune nutrition may decrease LOS and postoperative CRP levels in total hip arthroplasty.
  
  
  BACKGROUND
  
  
  
  RESULTS
  NCT02580214.
authors.affiliation: Brazilian Society of Orthopedics and Traumatology, Cuiabá, MT, Brazil.
authors.forename: Miguel Aprelino
authors.initials: MA
authors.lastname: Alito
authors.affiliation: Federal University of Mato Grosso, Cuiabá, Brazil, Cuiabá, Brazil. aguilar@terra.com.br.|UNIVAG, Varzea Geande, Brazil. aguilar@terra.com.br.|, Rodovia Helder Candia, Cond. Country casa 15, 78048-150, Cuiabá, Brazil. aguilar@terra.com.br.
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: de Aguilar-Nascimento
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001120:Arginine / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip; D002097:C-Reactive Protein / Q000378:metabolism; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D023381:Endpoint Determination; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009711:Nucleotides / Q000008:administration & dosage; D018529:Nutritional Support / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D010865:Pilot Projects; D011134:Polysaccharides / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011446:Prospective Studies; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D004040:Dietary Carbohydrates; D004044:Dietary Proteins; D015525:Fatty Acids, Omega-3; D006454:Hemoglobins; D009711:Nucleotides; D011134:Polysaccharides; D014815:Vitamins; C008315:maltodextrin; D002097:C-Reactive Protein; D001120:Arginine
keywords: C-reactive protein; Immune nutrition; Length of hospital stay; Perioperative care; Preoperative fasting; Total hip arthroplasty