title: Benefits of post-operative oral protein supplementation in gastrointestinal surgery patients: A systematic review of clinical trials.
abstract: OBJECTIVE
  To evaluate published trials examining oral post-operative protein supplementation in patients having undergone gastrointestinal surgery and assessment of reported results.
  
  
  METHODS
  Database searches (MEDLINE, BIOSIS, EMBASE, Cochrane Trials, Cinahl, and CAB), searches of reference lists of relevant papers, and expert referral were used to identify prospective randomized controlled clinical trials. The following terms were used to locate articles: "oral'' or "enteral'' and "postoperative care'' or "post-surgical'' and "proteins'' or "milk proteins'' or "dietary proteins'' or "dietary supplements'' or "nutritional supplements''. In databases that allowed added limitations, results were limited to clinical trials that studied humans, and publications between 1990 and 2014. Quality of collated studies was evaluated using a qualitative assessment tool and the collective results interpreted.
  
  
  RESULTS
  Searches identified 629 papers of which, following review, 7 were deemed eligible for qualitative evaluation. Protein supplementation does not appear to affect mortality but does reduce weight loss, and improve nutritional status. Reduction in grip strength deterioration was observed in a majority of studies, and approximately half of the studies described reduced complication rates. No changes in duration of hospital stay or plasma protein levels were reported. There is evidence to suggest that protein supplementation should be routinely provided post-operatively to this population. However, despite comprehensive searches, clinical trials that varied only the amount of protein provided via oral nutritional supplements (discrete from other nutritional components) were not found. At present, there is some evidence to support routinely prescribed oral nutritional supplements that contain protein for gastrointestinal surgery patients in the immediate post-operative stage.
  
  
  CONCLUSIONS
  The optimal level of protein supplementation required to maximise recovery in gastrointestinal surgery patients is effectively unknown, and may warrant further study.
authors.affiliation: Mike Crickmer, Colum P Dunne, Andrew O'Regan, J Calvin Coffey, Suzanne S Dunne, Graduate Entry Medical School, University of Limerick, Castletroy, V94 T9PX Limerick, Ireland.
authors.forename: Mike
authors.initials: M
authors.lastname: Crickmer
authors.affiliation: Mike Crickmer, Colum P Dunne, Andrew O'Regan, J Calvin Coffey, Suzanne S Dunne, Graduate Entry Medical School, University of Limerick, Castletroy, V94 T9PX Limerick, Ireland.
authors.forename: Colum P
authors.initials: CP
authors.lastname: Dunne
authors.affiliation: Mike Crickmer, Colum P Dunne, Andrew O'Regan, J Calvin Coffey, Suzanne S Dunne, Graduate Entry Medical School, University of Limerick, Castletroy, V94 T9PX Limerick, Ireland.
authors.forename: Andrew
authors.initials: A
authors.lastname: O'Regan
authors.affiliation: Mike Crickmer, Colum P Dunne, Andrew O'Regan, J Calvin Coffey, Suzanne S Dunne, Graduate Entry Medical School, University of Limerick, Castletroy, V94 T9PX Limerick, Ireland.
authors.forename: J Calvin
authors.initials: JC
authors.lastname: Coffey
authors.affiliation: Mike Crickmer, Colum P Dunne, Andrew O'Regan, J Calvin Coffey, Suzanne S Dunne, Graduate Entry Medical School, University of Limerick, Castletroy, V94 T9PX Limerick, Ireland.
authors.forename: Suzanne S
authors.initials: SS
authors.lastname: Dunne
keywords: Clinical trial; Gastrointestinal surgery; Oral supplementation; Protein supplementation; Systematic review