Impact of Oral Immunonutrition on Postoperative Morbidity in Digestive Oncologic Surgery
| Autor: | Claire Rives-Langes, Sandrine Katsahian, Amel Ait Boudaoud, Sébastien Gaujoux, Andrea Lazzati, Divya Danoussou, Alexandre Challine, Claire Carette, Sébastien Czernichow, Bertrand Dousset |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
business.industry Hazard ratio Cancer Odds ratio Anastomosis medicine.disease Logistic regression Confidence interval 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Internal medicine Medicine 030211 gastroenterology & hepatology Surgery business Survival analysis Cohort study |
| Zdroj: | Annals of Surgery. 273:725-731 |
| ISSN: | 1528-1140 0003-4932 |
| DOI: | 10.1097/sla.0000000000003282 |
| Popis: | OBJECTIVE The objective of the present study was to assess the effect of preoperative immunonutrition on a nationwide scale. BACKGROUND According to international guidelines, immunonutrition should be prescribed before major oncologic digestive surgery to decrease postoperative morbidity. Nevertheless, this practice remains controversial. METHODS We used a prospective national health database named "Echantillon generaliste des Beneficiaires." Patients were selected with ICD10 codes of cancer and digestive surgery procedures from 2012 to 2016. Two groups were identified: with reimbursement of immunonutrition 45 days before surgery (IN-group) or not (no-IN-group). Primary outcome was 90-day severe morbidity. Secondary outcomes were postoperative length of stay (LOS) and overall survival. Logistic regression and survival analysis adjusted with IPW method were performed. RESULTS One thousand seven hundred seventy-one patients were included. The proportion of different cancers was as follows: 72% patients were included in the colorectal group, 14% in the hepato-pancreato-biliary group, and 12% in the upper gastrointestinal group. Patients from the IN-group (n = 606, 34%) were younger (67.1 ± 11.8 vs 69.2 ± 12.2 years, P < 0.001), with increased use of other oral nutritional supplements (49.5% vs 31.8%, P < 0.001) and had more digestive anastomoses (89.4% vs 83.0%, P < 0.001). There was no significant difference between the 2 groups for 90-day severe morbidity [odds ratio (OR): 0.91, 95% confidence interval (95% CI): 0.73-1.14] or in survival (hazard ratio: 0.89, 95% CI: 0.73-1.08). LOS were shorter in the IN-group [-1.26 days, 95% CI: -2.40 to -0.10)]. CONCLUSION The preoperative use of immunonutrition before major oncologic digestive surgery was not associated with any significant difference in morbidity or mortality. However, the LOS was significantly shorter in the IN-group. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|