Nicholas R Rowan1, Jonas T Johnson2, Christina E Fratangelo3, Brenda K Smith4, Patricia A Kemerer5, Robert L Ferris6. 1. University of Pittsburgh Medical Center, Department of Otolaryngology Head & Neck Surgery, Eye & Ear Institute, Suite 500, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: rowannr@upmc.edu. 2. University of Pittsburgh Medical Center, Department of Otolaryngology Head & Neck Surgery, Eye & Ear Institute, Suite 500, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: johnsonjt@upmc.edu. 3. University of Pittsburgh Medical Center, Department of Otolaryngology Head & Neck Surgery, Eye & Ear Institute, Suite 500, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: mascce@upmc.edu. 4. UPMC Montefiore Hospital, Same Day Surgery Services, 3459 Fifth Avenue, Pittsburgh, PA 15213, United States. Electronic address: smithbk@upmc.edu. 5. University of Pittsburgh Medical Center, Department of Otolaryngology Head & Neck Surgery, Eye & Ear Institute, Suite 500, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: kemererpa@mail.magee.edu. 6. University of Pittsburgh Medical Center, Department of Otolaryngology Head & Neck Surgery, Eye & Ear Institute, Suite 500, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: ferrrl@upmc.edu.
Abstract
OBJECTIVES: Investigate both the utility and feasibility of perioperative nutritional supplementation with an arginine-enriched immunonutrition formula to high-risk head and neck cancer surgical patients and examine its effects on acute post-operative clinical outcomes. MATERIALS & METHODS: This prospective, non-randomized, interventional cohort study compared high-risk head and neck cancer surgical patients who consumed a pre- and post-operative arginine-based nutritional supplement to those that did not. Outcome measures included post-operative complications, length of hospitalization, readmission rates and measurement of nutritional biomarkers. RESULTS: 195 high-risk head and neck cancer surgical patients were enrolled. 59% of the patients used the nutritional supplement, 41% did not. Of the 80 patients who did not receive the immunonutrition formula, 38 (47.5%) experienced post-operative complications of all types as compared to 29 of the 115 (25.2%) patients who did consume the product (p=0.0021). Pharyngeal leaks or fistulas were the most common post-operative complications in both groups and more common in patients who did not receive supplementation (p=0.007). Length of stay was on average 2.8 days longer in patients who did not have enhanced nutrition (p=0.02), while readmission rates between the two groups were similar (p=0.91). Measurements of nutritional biomarkers were not reported secondary to low collection rates. CONCLUSION: Enhanced perioperative nutrition may result in significant reductions of post-operative fistula formations and decreased length of stay in a high-risk head and neck cancer population, even in the setting of poor compliance. The potential quality improvement in both patient care and healthcare cost is both real and significant.
OBJECTIVES: Investigate both the utility and feasibility of perioperative nutritional supplementation with an arginine-enriched immunonutrition formula to high-risk head and neck cancer surgical patients and examine its effects on acute post-operative clinical outcomes. MATERIALS & METHODS: This prospective, non-randomized, interventional cohort study compared high-risk head and neck cancer surgical patients who consumed a pre- and post-operative arginine-based nutritional supplement to those that did not. Outcome measures included post-operative complications, length of hospitalization, readmission rates and measurement of nutritional biomarkers. RESULTS: 195 high-risk head and neck cancer surgical patients were enrolled. 59% of the patients used the nutritional supplement, 41% did not. Of the 80 patients who did not receive the immunonutrition formula, 38 (47.5%) experienced post-operative complications of all types as compared to 29 of the 115 (25.2%) patients who did consume the product (p=0.0021). Pharyngeal leaks or fistulas were the most common post-operative complications in both groups and more common in patients who did not receive supplementation (p=0.007). Length of stay was on average 2.8 days longer in patients who did not have enhanced nutrition (p=0.02), while readmission rates between the two groups were similar (p=0.91). Measurements of nutritional biomarkers were not reported secondary to low collection rates. CONCLUSION: Enhanced perioperative nutrition may result in significant reductions of post-operative fistula formations and decreased length of stay in a high-risk head and neck cancer population, even in the setting of poor compliance. The potential quality improvement in both patient care and healthcare cost is both real and significant.
Authors: Carol R Bradford; Alfio Ferlito; Kenneth O Devaney; Antti A Mäkitie; Alessandra Rinaldo Journal: Laryngoscope Investig Otolaryngol Date: 2020-01-27
Authors: Matthew C Bozeman; Laura L Schott; Amarsinh M Desai; Mary K Miranowski; Dorothy L Baumer; Cynthia C Lowen; Zhun Cao; Krysmaru Araujo Torres Journal: J Health Econ Outcomes Res Date: 2022-07-01