Background
Malnourished elective major surgery patients are not routinely given nutrition support (NS) preoperatively in the Philippines owing to financial constraints and lack of evidence of benefit in the local patient population. Such patients frequently develop postoperative complications that may necessitate admission to the ICU. This pilot study was conducted to demonstrate the benefit of NS in such patients in terms of reduced ICU admissions.
Methods
Thirty-six malnourished and lymphopenic elective abdominal surgical patients (BMI <18.5 kg/m2 or weight loss >10% or SGA grade C) were given NS preoperatively for 5 days without (n = 18, group A) or with (n = 18, group B) parenteral glutamine. NS was given orally, enterally or parenterally in combinations to ensure delivery of energy 25–30 kcal/kg/day and of proteins 0.8–1.5 g/kg/day. For ethical reasons at the research centres, a control group (no NS) was not included.
Results
Postoperatively, only one (2.7%) patient required ICU admission. Compared with historical data in similar patients (>20% incidence; P < 0.05) the difference was significant. Complications included one (2.7%) each of wound infection, respiratory infection and wound dehiscence. Unlike group A, group B showed significant (P < 0.05) increases in granulocyte, lymphocyte and monocyte counts, which returned to normal at 7 days post-operation. See Table 1.
Table 1.
| WBC (/mm3) [median (IQR)] | ||||||
|---|---|---|---|---|---|---|
| Group A | Group B | |||||
| Preoperative day 7 | Day of operation | P value | Preoperative day 7 | Day of operation | P value | |
| Granulocytes | 4406.5 (3418–6221) | 5019 (4455–7368) | 0.07 | 6179 (4344–8664) | 9124 (6154–12,920) | 0.04 |
| Lymphocytes | 1689 (879–2326) | 1624 (790–2347) | 0.33 | 1486 (974–1711) | 1773 (1361–2285) | 0.02 |
| Monocytes | 526 (382–769) | 569 (395–790) | 0.39 | 613 (440–818) | 648 (392–912) | 0.02 |
| Total WBC | 6655 (5690–8640) | 7440 (6120–9670) | 0.14 | 8760 (5900–11,270) | 11,490 (8430–15,200) | 0.06 |
Conclusion
Preoperative NS resulted in a reduction in postoperative complications requiring ICU admission, at least in comparison with historical data of similar patients at the same institutions. Addition of glutamine to NS resulted in indicative immunologic benefits that may be worth further exploration.