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

Osland, Emma and Hossain, Md Belal and 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). pp. 53-69. ISSN 0148-6071

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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: RCTs 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 PRISMA recommendations.
Results: Twenty studies yielding twenty-one 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 LOS were found with perioperative and postoperative administration. Perioperative administration was also associated with a statistically significant reduction in anastomotic dehiscence while a reduction in non-infective complications was demonstrated with postoperative administration. Preoperative pharmaconutrition demonstrated no notable advantage over standard nutritional 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 of where further research is required.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: © 2013 American Society for Parenteral and Enteral Nutrition. Permanent restricted access to published version due to publisher copyright policy.
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Agricultural, Computational and Environmental Sciences
Date Deposited: 20 Feb 2015 23:31
Last Modified: 01 Jul 2016 04:44
Uncontrolled Keywords: immunonutrition; pharmaconutrition; gastrointestinal surgery; elective surgery; cancer; complications; meta-analysis; human
Fields of Research : 11 Medical and Health Sciences > 1199 Other Medical and Health Sciences > 119999 Medical and Health Sciences not elsewhere classified
01 Mathematical Sciences > 0104 Statistics > 010402 Biostatistics
11 Medical and Health Sciences > 1111 Nutrition and Dietetics > 111102 Dietetics and Nutrigenomics
Socio-Economic Objective: E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
E Expanding Knowledge > 97 Expanding Knowledge > 970101 Expanding Knowledge in the Mathematical Sciences
Identification Number or DOI: 10.1177/0148607112474825
URI: http://eprints.usq.edu.au/id/eprint/24765

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