Multidisciplinary Preoperative Immunonutrition Initiative in Colon and Rectal Surgery

Preoperative nutrition is an important consideration in patients undergoing abdominal surgery, and optimizing can result in fewer infectious complications. Enhanced recovery after surgery pathways endorse the use of nutritional supplementation in malnourished patients. However, there is conflicting literature as to the efficacy of immunonutrition supplementation (nutritional supplements that contain additional factors such as arginine and nucleotides) in the perioperative patient. The objective of this research is to study the association between immunonutrition and surgical complications in our study population.

This study is a retrospective cohort study of a quality improvement project using a cohort of 225 elective colectomy and proctectomy patients who received twice daily immunonutrition for 7 d before surgery (exposed cohort) between March 2022 and April 2023, and a cohort of 686 similar patients between 2018 and 2022 before the implementation of this initiative (unexposed cohort). This is a single-site study performed at the University of Massachusetts Memorial Medical Center. The primary endpoint is a reduction in the number of surgical site infections in the exposed cohort compared to the unexposed cohort. Secondary endpoints include postoperative complications, length of stay, 30-d mortality, and compliance.

There were no statistically significant differences in rates of surgical site infections or any other complications between the exposed and unexposed cohorts.

Although this study did not demonstrate a reduction in complications, there were notable trends in our subgroup analysis that require further investigation with a larger cohort and improved compliance.