| Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. | |
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MedLine Citation:
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PMID: 10593328 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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M Senkal; V Zumtobel; K H Bauer; B Marpe; G Wolfram; A Frei; U Eickhoff; M Kemen |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Archives of surgery (Chicago, Ill. : 1960) Volume: 134 ISSN: 0004-0010 ISO Abbreviation: Arch Surg Publication Date: 1999 Dec |
Date Detail:
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Created Date: 1999-12-22 Completed Date: 1999-12-22 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9716528 Medline TA: Arch Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1309-16 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adjuvants, Immunologic
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administration & dosage* Aged Docosahexaenoic Acids / blood Double-Blind Method Eicosapentaenoic Acid / blood Enteral Nutrition / economics* Fatty Acids, Omega-3 / blood Female Food, Formulated* Gastrointestinal Neoplasms / mortality, pathology, surgery* Humans Male Middle Aged Neoplasm Staging Prospective Studies |
| Chemical | |
Reg. No./Substance:
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0/Adjuvants, Immunologic; 0/Fatty Acids, Omega-3; 1553-41-9/Eicosapentaenoic Acid; 25167-62-8/Docosahexaenoic Acids |
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