Association of perioperative immunonutrition with anastomotic leak among patients undergoing elective colorectal surgery within a robust enhanced recovery after surgery program

被引：0
作者：
Younan, Samuel A. [1 ]
Ali, Danish [1 ]
Hawkins, Alexander T. [1 ]
Bradley III, Joel F. Bradley [2 ]
Hopkins, M. Benjamin [1 ]
Geiger, Timothy [1 ]
Jayaram, Jennifer
Khan, Aimal [1 ,3 ]
机构：
[1] Vanderbilt Univ, Med Ctr, Div Gen Surg, Sect Colon & Rectal Surg, Nashville, TN 37232 USA
[2] Vanderbilt Univ, Med Ctr, Dept Surg, Div Gen Surg, Nashville, TN 37232 USA
[3] Vanderbilt Univ, Med Ctr, Dept Anesthesiol, Nashville, TN 37232 USA
来源：
SURGERY | 2025年 / 181卷
关键词：
SURGICAL SITE INFECTION; POSTOPERATIVE COMPLICATIONS; ENTERAL IMMUNONUTRITION; ANTERIOR RESECTION; CANCER-SURGERY; RECTAL-CANCER; RISK-FACTORS; ARGININE; IMMUNE; METAANALYSIS;
D O I：
10.1016/j.surg.2025.109159
中图分类号：
R61 [外科手术学];
学科分类号：
摘要：
Background: Immunonutrition supplementation has been shown to reduce the risk of surgical infectious complications; however, its effect on decreasing anastomotic leak rates, in the context of an otherwise robust Enhanced Recovery After Surgery (ERAS) program, remains unclear. This study aims to assess the association between perioperative immunonutrition supplementation and anastomotic leak in an elective Enhanced Recovery After Surgery colorectal surgical population. Methods: We performed a retrospective single-institution cohort study consisting of adult patients enrolled in an Enhanced Recovery After Surgery pathway and undergoing elective colorectal surgery from 2018 to 2023. Immunonutrition supplementation was defined as a 10-day perioperative supply of commercially available nutritional shakes. Relevant demographic covariates, preoperative characteristics, and operative methods were identified and analyzed. Multivariable logistic regression was performed to determine the association of immunonutrition with anastomotic leak. Results: A total of 708 patients were included in the study, of which n = 400 (56.5%) received perioperative immunonutrition. Patients who received immunonutrition were more likely to be older (median age 57.9 vs 55.7), male (52.7% vs 44.8%), have a higher body mass index (27.7 vs 26.3), and less likely to be current smokers (9.8% vs 16.2%). On adjusted analysis, there was no association between immunonutrition use and anastomotic leak (odds ratio = 0.96, 95% confidence interval = 0.45, 2.08), 30-day readmission (odds ratio = 0.97, 95% confidence interval = 0.60, 1.57), or length of stay (b = .40, 95% confidence interval =-0.06, 0.86) Conclusion: We did not observe an association between perioperative immunonutrition supplementation and postoperative anastomotic leak, suggesting that the role of immunonutrition within a comprehensive Enhanced Recovery After Surgery program for elective colorectal surgery may warrant further evaluation. (c) 2025 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
引用
收藏
页数：8
相关论文
共 36 条
  • [1] Friel C.M., Kin C.J., Anastomotic complications, The ASCRS Textbook of Colon and Rectal Surgery, pp. 189-206, (2022)
  • [2] Enker W.E., Merchant N., Cohen A.M., Et al., Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service, Ann Surg, 230, pp. 544-552, (1999)
  • [3] Law W.L., Chu K.W., Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients, Ann Surg, 240, pp. 260-268, (2004)
  • [4] Paun B.C., Cassie S., MacLean A.R., Et al., Postoperative complications following surgery for rectal cancer Risk factors for leak, complications and mortality after ileocolic anastomosis: comparison of two anastomotic techniques, Ann Surg, 251, pp. 807-818, (2010)
  • [5] Sanchez-Guillen L., Frasson M., Garcia-Granero A., Et al., Risk factors for leak, complications and mortality after ileocolic anastomosis: comparison of two anastomotic techniques, Ann R Coll Surg Engl, 101, pp. 571-578, (2019)
  • [6] Midura E.F., Hanseman D., Davis B.R., Et al., Risk factors and consequences of anastomotic leak after colectomy: a national analysis, Dis Colon Rectum, 58, pp. 333-338, (2015)
  • [7] Thornblade L.W., Varghese T.K., Shi X., Et al., Preoperative immunonutrition and elective colorectal resection outcomes, Dis Colon Rectum, 60, pp. 68-75, (2017)
  • [8] Cohen M.E., Bilimoria K.Y., Ko C.Y., Et al., Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery A combined measure of procedural volume and outcome to assess hospital quality of colorectal cancer surgery, a secondary analysis of clinical audit data, J Am Coll Surg, 208, pp. 1009-1016, (2009)
  • [9] Govaert J.A., van Dijk W.A., Fiocco M., Et al., Nationwide outcomes measurement in colorectal cancer surgery: improving quality and reducing costs, J Am Coll Surg, 222, pp. 19-29.e2, (2016)
  • [10] Kolfschoten N.E., Marang-van de Mheen P.J., Wouters M.W., Et al., A combined measure of procedural volume and outcome to assess hospital quality of colorectal cancer surgery, a secondary analysis of clinical audit data, PLoS One, 9, (2014)
1234