Multidisciplinary Preoperative Immunonutrition Initiative in Colon and Rectal Surgery.

No statistically significant differences in surgical site infection rates were found between patients who received preoperative immunonutrition and those who did not.

• The primary endpoint was reduction in surgical site infections in the exposed cohort compared to the unexposed cohort.
• The exposed cohort consisted of 225 elective colectomy and proctectomy patients who received twice daily immunonutrition for 7 days before surgery between March 2022 and April 2023.
• The unexposed cohort consisted of 686 similar patients between 2018 and 2022 before implementation of the initiative.
• No statistically significant differences were found in rates of surgical site infections between the two cohorts.

No statistically significant differences were found in any secondary postoperative outcomes between the exposed and unexposed cohorts.

• Secondary endpoints included postoperative complications, length of stay, 30-day mortality, and compliance.
• None of the secondary endpoints showed statistically significant differences between the exposed and unexposed cohorts.
• The study was conducted as a single-site retrospective cohort study at the University of Massachusetts Memorial Medical Center.

The study identified notable trends in subgroup analysis that the authors believe warrant further investigation.

• Although no overall significant differences were found, the authors noted 'notable trends in our subgroup analysis that require further investigation with a larger cohort and improved compliance.'
• The authors specifically cited the need for a larger cohort and improved compliance as prerequisites for more definitive conclusions.
• The study was framed as a quality improvement project, which may have affected the rigor of compliance tracking.

The study was designed as a retrospective cohort quality improvement project examining elective colorectal surgery patients receiving immunonutrition supplementation containing arginine and nucleotides.

• Immunonutrition was defined as 'nutritional supplements that contain additional factors such as arginine and nucleotides.'
• The intervention consisted of twice daily immunonutrition for 7 days before surgery.
• The study population included patients undergoing elective colectomy and proctectomy.
• The initiative was implemented as part of an Enhanced Recovery After Surgery (ERAS) pathway context, which endorses nutritional supplementation in malnourished patients.

The existing literature on perioperative immunonutrition efficacy is described as conflicting.

• The authors noted 'there is conflicting literature as to the efficacy of immunonutrition supplementation in the perioperative patient.'
• Preoperative nutritional optimization has been associated with fewer infectious complications in patients undergoing abdominal surgery.
• Enhanced Recovery After Surgery pathways endorse the use of nutritional supplementation in malnourished patients.