Outcome and cost-effectiveness of perioperative enteral immunonutrition inpatients undergoing elective upper gastrointestinal tract surgery - A prospective randomized study

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 re measured. 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.