M. Senkal et al., Outcome and cost-effectiveness of perioperative enteral immunonutrition inpatients undergoing elective upper gastrointestinal tract surgery - A prospective randomized study, ARCH SURG, 134(12), 1999, pp. 1309-1316
Hypothesis: Perioperatively administered enteral immunonutrition will impro
ve early postoperative morbidity and cost-effectiveness after gastrointesti
nal tract surgery.
Design: A prospective, randomized, double-blind, multicenter clinical trial
Setting: Surgical departments in German university and teaching hospitals.
Patients: One hundred fifty-four patients with upper gastrointestinal tract
malignant neoplasms who were eligible for analysis.
Intervention: Preoperatively, patients received 5 days of oral immunonutrit
ion (an arginine-, RNA-, and omega 3 fatty acid-supplemented diet) or an is
oenergetic control diet (1 L/d). Early postoperative enteral feeding with i
mmunonutrition or an isoenergetic, isonitrogenous control diet using a cath
eter jejunostomy was performed for 10 days.
Main Outcome Measures: Postoperative infectious complications, their treatm
ent costs, and cost-effectiveness of immunonutrition were analyzed. Plasma
levels of the fatty acids eicosapentaenoic acid and docosahexaenoic acid we
Results: In the immunonutrition group, significantly fewer infectious compl
ication events occurred (14 vs 27; P = .05). The number of patients with co
mplications was significantly lower in the supplemented diet group after po
stoperative day 3 (7 vs 16; P = .04). The treatment costs of complications
in the supplemented diet group were suggestively lower than in the control
diet group (DM 75 172 vs DM 204 273). Cost-effectiveness was DM 1503 in the
experimental group vs DM 3587 in the control group, where DM denotes deuts
che mark (German currency).
Conclusion: The perioperative administration of an enteral immunonutrition
significantly (P = .05) decreased the early occurrence of postoperative inf
ections and reduced substantially the treatment costs of the complications
after major upper gastrointestinal tract surgery.