Perioperative Immunonutrition in Elderly Patients Undergoing Total Hip and Knee Arthroplasty: Impact on Postoperative Outcomes

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 45; no. 7; pp. 1559 - 1566
• Main Authors: Gonçalves, Thiago José Martins, Gonçalves, Sandra Elisa Adami Batista, Nava, Natássia, Jorge, Valeria Conceição, Okawa, Andrea Massone, Rocha, Vanessa Azevedo, Forato, Luciana Carolina Henrique, Furuya, Vicky Akemi Onizuca, Martins, Sandra Salvador, Oksman, Daniel
• Format: Journal Article
• Language: English
• Published: United States 01.09.2021
• Subjects: Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; elderly; Female; Humans; immunonutrition; infectious complications; length of stay; Postoperative Complications - prevention & control; Quality of Life; Retrospective Studies; total hip arthroplasty; total knee arthroplasty; length of stay; total hip arthroplasty; total knee arthroplasty; immunonutrition; elderly; infectious complications
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1002/jpen.2028

Background Arthroplasties in elderly patients are surgeries performed to ensure their quality of life. Perioperative care with specific nutrients can improve nutrition status and metabolic response to orthopedic surgeries, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods Retrospective study with elderly patients divided into 2 groups: control and immunonutrition. The immunonutrition group was instructed to start oral intake of the nutrition supplement 5 days before and to resume it 5 days after arthroplasty (200 mL, 3 times per day). The following were analyzed as primary and secondary outcomes: length of stay (LOS), infectious and noninfectious complications, need for intensive care unit (ICU), transfusion requirement, and C‐reactive protein. Results A total of 3015 elderly patients met the inclusion criteria: control group (n = 1398) and immunonutrition group (n = 1617). Overall, 81.2% were women and mean age was 72.6 ± 6.9 years. Immunonutrition group had a shorter LOS in hours (32.0 ± 19.4 vs 56.0 ± 26.4; P < .001) and lower rates of infectious complications (2.2% vs 4.6%; P < .001). Noninfectious complications and need for ICU also had lower rates in the immunonutrition group. In the logistic regression analysis, immunonutrition reduced the chance of infectious complications by 55% (odds ratio [OR], 0.45; 95% CI, 0.30–0.68; P < .001) even after adjusting for variables (OR, 0.45; 95% CI, 0.28–0.71; P < .001). Conclusion Perioperative immunonutrition in elderly patients undergoing THA or TKA may shorten postoperative LOS and reduce infectious and noninfectious complications and transfusion requirement.