Pre-operative immunonutrition therapy in upper gastrointestinal cancer patients: Post-operative outcomes and patient acceptance

Abstract

© 2017, Australasian Medical Journal Pty Ltd. All rights reserved. Background Pre-operative immunonutrition for upper gastrointestinal cancer patients is provided in a number of Australian tertiary hospitals. However, previous studies yielded inconsistent results; limited information on patient acceptance of pre-operative supplementation is likely to be an as yet unexplored contributing factor. Aims To determine patient acceptance of a pre-operative immunonutrition supplement protocol and to compare post-operative outcomes pre- and post-implementation of the protocol. Methods A retrospective review of medical records was undertaken for upper gastrointestinal cancer surgery patients pre- and post-implementation of a pre-operative immunonutrition protocol. Endpoints noted were surgery type, timing of attendance at the pre-admission clinic, post-operative complications, intensive care unit admissions, dietprogression and length of stay. Patient feedback on the immunonutrition protocol and supplement acceptability was obtained via interview. Results The audit identified 74 patients as having undergone upper gastrointestinal cancer surgery (36 patients pre- and 38 patients post-implementation). Less than half of the post-implementation patients attended the pre-admission clinic as per protocol. Infectious and non-infectious complication rates were similar between the two groups. Number of days until patients received full diets post-operatively were 0.80 days shorter post-implementation, but not statistically significant. Patients in the post-implementation group with infective complications spent significantly longer time nil by mouth than those who did not incur complications (26.15 vs 17.13 days, p=0.024). Length of stay was 1.5 days shorter in the post-implementation group but not statistically different. Conclusion We found no difference in post-operative outcomes; however, the pre- and post-implementation comparison was limited by poor adherence to the protocol as a consequence of late attendance at pre-admission clinic. Of those who did attend as planned, patient acceptance was high. Future studies incorporating prospective, quantitative pre-operative immunonutrition intake are needed.