Abstract:
Introduction: Effects of timing of immunonutrition administration (preoperative vs. postoperative vs. perioperative) and compliance on surgical outcomes for patients
undergoing major operation for cancer is unclear.
Methods: This study was a prospective, non-randomized trial of patients undergoing surgical management of gastrointestinal, gynecologic, and urologic malignancies
between 2017 and 2021. Participants underwent teaching and instructed to take IMPACT Advanced Recovery (AR) Formula three times daily for five days
before and after surgery once cleared by the surgeon for clear liquid diet. The dietician tracked their adherence. For each period (preoperative and postoperative),
those who took in 12 to 15 cartons were considered highly compliant; 8 to 11 cartons were considered moderately compliant; less than 8 were considered
minimally compliant.
Results: The final study size included 115 patients. Only, 33 patients (28.7%) were considered highly compliant throughout the perioperative period. Nearly 81 (70.4%)
patients were highly compliant in the preoperative period. Postoperative compliance was substantially lower with only 27 (23.5%) patients considered highly
compliant. The overall study demonstrated a postoperative complication rate of 14.8% with composite infection rate of 9.6%, superficial surgical site infection
rate of 5.2%, and deep wound infection rate of 2.6%. The 30-day hospital readmission rate was 20%.
Within the postoperative only compliance analysis, the high compliance group resulted in better unadjusted outcomes with lower rates of postoperative
complications (20.3% vs. 14.3% vs 0.0%), composite infections (13.5% vs 7.1% vs 0.0%), SSI (6.8% vs 7.1% vs 0.0%), deep wound infections (4.1% vs 0.0%
vs 0.0%), non-infectious complications (6.8% vs 7.1% vs 0.0%), and hospital readmissions within 30 days (24.3% vs 14.3% vs 11.1%). Within the preoperative
only compliance analysis, the high compliance group did not result in better unadjusted outcomes.
Conclusion Improved immunonutrition compliance appears to have a positive impact on surgical outcomes when consumed in the postoperative period. Further studies need
to be done addressing the potential dose-response relationship of immunonutrition intake. Additionally, compliance needs to be promoted during the
postoperative period as there appears to be a significant drop off in compliance during this phase.
Keywords: Arginine Supplementation, Immunonutrition, IMPACT, Quality Improvement, HIPEC
