Multimodal perioperative care plus immunonutrition versus traditional care in total hip arthroplasty: a randomized pilot study

作者：Alito Miguel Aprelino; de Aguilar Nascimento Jose Eduardo^*

来源：Nutrition Journal, 2016, 15(1): 34.

DOI：10.1186/s12937-016-0153-1

• Total hip arthroplasty
• Perioperative care
• C-reactive protein
• Preoperative fasting
• Immune nutrition
• Length of hospital stay

Background: Multimodal protocols of perioperative care may enhance postoperative recovery. However, limited information is available on preoperative immune and carbohydrate (CHO)-enriched drinks in patients undergoing hip arthroplasty. We aimed to investigate the effect of a multimodal protocol (ACERTO protocol) plus preoperative immune nutrition on the length of stay (LOS) and the postoperative acute phase response of patients undergoing total hip arthroplasty.
Methods: Thirty-two patients (mean age, 58 years; range, 26-85 years; 16 males) were randomized to receive either the ACERTO protocol (n = 15, ACERTO Group), which consisted of 6 h preoperative fasting for solids, an oral drink (200 mL of 12.5 % maltodextrin) up to 2 h before induction of anesthesia, restricted intravenous fluids (only 1000 mL of crystalloid fluid after surgery) and preoperative immune nutrition (600 mL/day of Impact - Nestle, Brazil) for five days prior to surgery, or traditional care (n = 17; control group), which consisted of 6-8 h preoperative fasting, intravenous hydration until the 1st postoperative day and no preoperative immune supplementation. The main endpoint was LOS. C-reactive protein (CRP) was the secondary endpoint and was assessed during induction of anesthesia and on postoperative day 2.
Results: Neither deaths nor postoperative complications occurred. The median LOS was 3 (2-5) days in the ACERTO group and 6 (3-8) days in controls (P < 0.01). Postoperative CRP was higher in the control group (P < 0.01).
Conclusion: The ACERTO multimodal protocol of perioperative care plus preoperative immune nutrition may decrease LOS and postoperative CRP levels in total hip arthroplasty.

• 出版日期2016-4-2