Document Detail

Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study.
MedLine Citation:
PMID:  10593328     Owner:  NLM     Status:  MEDLINE    
HYPOTHESIS: Perioperatively administered enteral immunonutrition will improve early postoperative morbidity and cost-effectiveness after gastrointestinal 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 immunonutrition (an arginine-, RNA-, and omega3 fatty acid-supplemented diet) or an isoenergetic control diet (1 L/d). Early postoperative enteral feeding with immunonutrition or an isoenergetic, isonitrogenous control diet using a catheter jejunostomy was performed for 10 days. MAIN OUTCOME MEASURES: Postoperative infectious complications, their treatment costs, and cost-effectiveness of immunonutrition were analyzed. Plasma levels of the fatty acids eicosapentaenoic acid and docosahexaenoic acid were measured. RESULTS: In the immunonutrition group, significantly fewer infectious complication events occurred (14 vs 27; P = .05). The number of patients with complications was significantly lower in the supplemented diet group after postoperative 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 75172 vs DM 204273). Cost-effectiveness was DM 1503 in the experimental group vs DM 3587 in the control group, where DM denotes deutsche mark (German currency). CONCLUSION: The perioperative administration of an enteral immunonutrition significantly (P = .05) decreased the early occurrence of postoperative infections and reduced substantially the treatment costs of the complications after major upper gastrointestinal tract surgery.
M Senkal; V Zumtobel; K H Bauer; B Marpe; G Wolfram; A Frei; U Eickhoff; M Kemen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  134     ISSN:  0004-0010     ISO Abbreviation:  Arch Surg     Publication Date:  1999 Dec 
Date Detail:
Created Date:  1999-12-22     Completed Date:  1999-12-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1309-16     Citation Subset:  AIM; IM    
Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Germany.
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MeSH Terms
Adjuvants, Immunologic / administration & dosage*
Docosahexaenoic Acids / blood
Double-Blind Method
Eicosapentaenoic Acid / blood
Enteral Nutrition / economics*
Fatty Acids, Omega-3 / blood
Food, Formulated*
Gastrointestinal Neoplasms / mortality,  pathology,  surgery*
Middle Aged
Neoplasm Staging
Prospective Studies
Reg. No./Substance:
0/Adjuvants, Immunologic; 0/Fatty Acids, Omega-3; 1553-41-9/Eicosapentaenoic Acid; 25167-62-8/Docosahexaenoic Acids

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