Perioperative Immunonutrition in Elderly Patients Undergoing Total Hip and Knee Arthroplasty: Impact on Postoperative Outcomes.

Autor: Gonçalves TJM; Department of Orthopedic Surgery, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil., Gonçalves SEAB; Department of Orthopedic Surgery, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil., Nava N; Department of Orthopedic Surgery, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil., Jorge VC; Department of Orthopedic Surgery, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil., Okawa AM; Department of Orthopedic Surgery, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil., Rocha VA; Department of Orthopedic Surgery, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil., Forato LCH; Department of Orthopedic Surgery, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil., Furuya VAO; Department of Orthopedic Surgery, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil., Martins SS; Department of Orthopedic Surgery, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil., Oksman D; Department of Orthopedic Surgery, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: JPEN. Journal of parenteral and enteral nutrition [JPEN J Parenter Enteral Nutr] 2021 Sep; Vol. 45 (7), pp. 1559-1566. Date of Electronic Publication: 2020 Oct 29.
DOI: 10.1002/jpen.2028
Abstrakt: Background: Arthroplasties in elderly patients are surgeries performed to ensure their quality of life. Perioperative care with specific nutrients can improve nutrition status and metabolic response to orthopedic surgeries, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA).
Methods: Retrospective study with elderly patients divided into 2 groups: control and immunonutrition. The immunonutrition group was instructed to start oral intake of the nutrition supplement 5 days before and to resume it 5 days after arthroplasty (200 mL, 3 times per day). The following were analyzed as primary and secondary outcomes: length of stay (LOS), infectious and noninfectious complications, need for intensive care unit (ICU), transfusion requirement, and C-reactive protein.
Results: A total of 3015 elderly patients met the inclusion criteria: control group (n = 1398) and immunonutrition group (n = 1617). Overall, 81.2% were women and mean age was 72.6 ± 6.9 years. Immunonutrition group had a shorter LOS in hours (32.0 ± 19.4 vs 56.0 ± 26.4; P < .001) and lower rates of infectious complications (2.2% vs 4.6%; P < .001). Noninfectious complications and need for ICU also had lower rates in the immunonutrition group. In the logistic regression analysis, immunonutrition reduced the chance of infectious complications by 55% (odds ratio [OR], 0.45; 95% CI, 0.30-0.68; P < .001) even after adjusting for variables (OR, 0.45; 95% CI, 0.28-0.71; P < .001).
Conclusion: Perioperative immunonutrition in elderly patients undergoing THA or TKA may shorten postoperative LOS and reduce infectious and noninfectious complications and transfusion requirement.
(© 2020 The Authors. Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.)
Databáze: MEDLINE
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