Effect of timing of pharmaconutrition (immunonutrition) administration on outcomes of elective surgery for gastrointestinal malignancies: a systematic review and meta-analysis

Osland, Emma, Hossain, Md Belal, Khan, Shahjahan and Memon, Muhammed Ashraf (2014) Effect of timing of pharmaconutrition (immunonutrition) administration on outcomes of elective surgery for gastrointestinal malignancies: a systematic review and meta-analysis. Journal of Parenteral and Enteral Nutrition, 38 1: 53-69. doi:10.1177/0148607112474825


Author Osland, Emma
Hossain, Md Belal
Khan, Shahjahan
Memon, Muhammed Ashraf
Title Effect of timing of pharmaconutrition (immunonutrition) administration on outcomes of elective surgery for gastrointestinal malignancies: a systematic review and meta-analysis
Journal name Journal of Parenteral and Enteral Nutrition   Check publisher's open access policy
ISSN 0148-6071
1941-2444
Publication date 2014-01-01
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1177/0148607112474825
Open Access Status Not Open Access
Volume 38
Issue 1
Start page 53
End page 69
Total pages 17
Place of publication Thousand Oaks, CA, United States
Publisher Sage
Language eng
Formatted abstract
Background: Pharmaconutrition has previously been reported in elective surgery to reduce postoperative infective complications and duration of hospital length of stay.

Objective: To update previously published meta-analyses and elucidate potential benefits of providing arginine-dominant pharmaconutrition in surgical patients specifically with regard to the timing of administration of pharmaconutrition.

Design: Randomized controlled trials comparing the use of pharmaconutrition with standard nutrition in elective adult surgical patients between 1980 and 2011 were identified. The meta-analysis was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations.

Results: Twenty studies yielding 21 sets of data met inclusion criteria. A total of 2005 patients were represented (pharmaconutrition, n = 1010; control, n = 995), in whom pharmaconutrition was provided preoperatively (k = 5), perioperatively (k = 2), or postoperatively (k = 14). No differences were seen in postoperative mortality with the provision of pharmaconutrition irrespective of timing of administration. Statistically significant reductions in infectious complications and length of stay were found with perioperative and postoperative administration. Perioperative administration was also associated with a statistically significant reduction in anastomotic dehiscence, whereas a reduction in noninfective complications was demonstrated with postoperative administration. Preoperative pharmaconutrition demonstrated no notable advantage over standard nutrition provision in any of the clinical outcomes assessed.

Conclusions: This meta-analysis highlights the importance of timing as a clinical consideration in the provision of pharmaconutrition in elective gastrointestinal surgical patients and identifies areas where further research is required. 
Keyword Cancer
Complications
Elective surgery
Gastrointestinal surgery
Human
Immunonutrition
Meta-analysis
Pharmaconutrition
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Medicine Publications
 
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