Does intravenous fish oil benefit patients post-surgery? A meta-analysis of randomised controlled trials

Background and aims: Supplementation of fish oil (FO) containing lipid emulsions has been associated with a reduction in the length of hospital stay, infections and liver dysfunction in patients undergoing major surgery. We carried out a meta-analysis and subgroup analysis to examine randomised clinical trial (RCT)-based evidence of the aforementioned effects. Methods: Four databases, reference lists and the WHO ICTRP were systematically searched for RCTs to access the clinical efficacy of fish oil-enriched total parenteral nutrition in post-surgery patients. Methodological quality assessment was based on the Cochrane Handbook and GRADE. Results: Twenty-one RCTs were enrolled for meta-analysis. FO was associated with a significant reduction in the length of hospital stay (mean = -2.14 d, 95% CI = -3.02 to -1.27), infections (OR = 0.53, 95% CI = 0.35-0.81), ALT (mean = -6.35 U/L, 95% CI = -11.75 to 0.94), GGT (mean = -11.01 U/L, 95% Cl = -20.77 to -1.25) and total bilirubin (mean = -2.06 mu mol/L, 95% CI = -3.6 to -0.52), as well as a non-significant change in mortality and postoperative medical cost. The quality of evidence of each clinical outcome was accessed as high. Conclusion: FO-enriched lipid emulsions are likely to reduce infections, the length of hospital stay and liver dysfunction without influencing mortality and may be a safe and preferable choice in post-surgery patients. Further well-designed trials should be performed to determine whether FO lipid emulsions reduce mortality in patients undergoing hepatic surgery, especially liver transplantation, and the cost effectiveness of such treatment. (C) 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.