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

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Abstract

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.

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Most cited references 43

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The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study.

Marita Cross, Emma Smith, Damian Hoy … (2014)

To estimate the global burden of hip and knee osteoarthritis (OA) as part of the Global Burden of Disease 2010 study and to explore how the burden of hip and knee OA compares with other conditions. Systematic reviews were conducted to source age-specific and sex-specific epidemiological data for hip and knee OA prevalence, incidence and mortality risk. The prevalence and incidence of symptomatic, radiographic and self-reported hip or knee OA were included. Three levels of severity were defined to derive disability weights (DWs) and severity distribution (proportion with mild, moderate and severe OA). The prevalence by country and region was multiplied by the severity distribution and the appropriate disability weight to calculate years of life lived with disability (YLDs). As there are no deaths directly attributed to OA, YLDs equate disability-adjusted life years (DALYs). Globally, of the 291 conditions, hip and knee OA was ranked as the 11th highest contributor to global disability and 38th highest in DALYs. The global age-standardised prevalence of knee OA was 3.8% (95% uncertainty interval (UI) 3.6% to 4.1%) and hip OA was 0.85% (95% UI 0.74% to 1.02%), with no discernible change from 1990 to 2010. Prevalence was higher in females than males. YLDs for hip and knee OA increased from 10.5 million in 1990 (0.42% of total DALYs) to 17.1 million in 2010 (0.69% of total DALYs). Hip and knee OA is one of the leading causes of global disability. Methodological issues within this study make it highly likely that the real burden of OA has been underestimated. With the aging and increasing obesity of the world's population, health professions need to prepare for a large increase in the demand for health services to treat hip and knee OA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030

Matthew Sloan, Ajay Premkumar, Neil Sheth (2018)

The volume of primary total joint arthroplasty (TJA) procedures has risen in recent decades. However, recent procedure growth has not been at previously projected exponential rates. To anticipate the future expense of TJA, updated models are necessary to predict TJA volume in the U.S.

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Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature.

Olivier Ethgen, Olivier Bruyère, Florent F. Richy … (2004)

Total hip and total knee arthroplasties are well accepted as reliable and suitable surgical procedures to return patients to function. Health-related quality-of-life instruments have been used to document outcomes in order to optimize the allocation of resources. The objective of this study was to review the literature regarding the outcomes of total hip and knee arthroplasties as evaluated by health-related quality-of-life instruments. The Medline and EMBASE medical literature databases were searched, from January 1980 to June 2003, to identify relevant studies. Studies were eligible for review if they met the following criteria: (1). the language was English or French, (2). at least one well-validated and self-reported health-related quality of life instrument was used, and (3). a prospective cohort study design was used. Of the seventy-four studies selected for the review, thirty-two investigated both total hip and total knee arthroplasties, twenty-six focused on total hip arthroplasty, and sixteen focused on total knee arthroplasty exclusively. The most common diagnosis was osteoarthritis. The duration of follow-up ranged from seven days to seven years, with the majority of studies describing results at six to twelve months. The Short Form-36 and the Western Ontario and McMaster University Osteoarthritis Index, the most frequently used instruments, were employed in forty and twenty-eight studies, respectively. Seventeen studies used a utility index. Overall, total hip and total knee arthroplasties were found to be quite effective in terms of improvement in health-related quality-of-life dimensions, with the occasional exception of the social dimension. Age was not found to be an obstacle to effective surgery, and men seemed to benefit more from the intervention than did women. When improvement was found to be modest, the role of comorbidities was highlighted. Total hip arthroplasty appears to return patients to function to a greater extent than do knee procedures, and primary surgery offers greater improvement than does revision. Patients who had poorer preoperative health-related quality of life were more likely to experience greater improvement. Health-related quality-of-life data are valuable, can provide relevant health-status information to health professionals, and should be used as a rationale for the implementation of the most adequate standard of care. Additional knowledge and scientific dissemination of surgery outcomes should help to ensure better management of patients undergoing total hip or total knee arthroplasty and to optimize the use of these procedures.

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Author and article information

Contributors

Thiago José Martins Gonçalves:

ORCID: https://orcid.org/0000-0001-8229-7917

thiagojmg@yahoo.com.br

Journal

Journal ID (nlm-ta): JPEN J Parenter Enteral Nutr

Journal ID (iso-abbrev): JPEN J Parenter Enteral Nutr

Journal ID (doi): 10.1002/(ISSN)1941-2444

Journal ID (publisher-id): JPEN

Title: JPEN. Journal of Parenteral and Enteral Nutrition

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0148-6071

ISSN (Electronic): 1941-2444

Publication date (Electronic): 29 October 2020

Publication date (Print): September 2021

Volume: 45

Issue: 7 ( doiID: 10.1002/jpen.v45.7 )

Pages: 1559-1566

Affiliations

[ ¹ ] Department of Orthopedic Surgery Sancta Maggiore Hospital, Prevent Senior Private Health Operator São Paulo Brazil

Author notes

[*] [* ] Corresponding Author:

Thiago José Martins Gonçalves, MD, Rua Lourenço Marques, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, 158–Vila Olímpia, São Paulo, SP 04547‐100, Brazil.

Email: thiagojmg@ 123456yahoo.com.br

Author information

Thiago José Martins Gonçalves https://orcid.org/0000-0001-8229-7917

Article

Publisher ID: JPEN2028

DOI: 10.1002/jpen.2028

PMC ID: 8518379

PubMed ID: 33044001

SO-VID: 834c959c-c4cb-4a09-adc1-fde39ded4abd

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date revision received : 20 September 2020

Date received : 29 July 2020

Date accepted : 01 October 2020

Page count

Figures: 1, Tables: 5, Pages: 8, Words: 5627

Custom metadata

source-schema-version-number 2.0

cover-date September 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.8 mode:remove_FC converted:15.10.2021

ScienceOpen disciplines: Nutrition & Dietetics

Keywords: elderly,immunonutrition,infectious complications,length of stay,total knee arthroplasty,total hip arthroplasty

Data availability:

ScienceOpen disciplines: Nutrition & Dietetics

Keywords: elderly, immunonutrition, infectious complications, length of stay, total knee arthroplasty, total hip arthroplasty

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

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Most cited references 43

The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study.

Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030

Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature.

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