Multimodal Perioperative Care Plus Immunonutrition Versus Traditional Care in Total Hip Arthroplasty: a Randomized Pilot Study

Overview

Journal Nutr J

Publisher Biomed Central

Specialty Nutritional Sciences

Date 2016 Apr 4

PMID 27038614

Citations 11

Authors

Miguel Aprelino Alito

Jose Eduardo de Aguilar-Nascimento

Affiliations

Soon will be listed here.

Abstract

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 - Nestlé, 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 1(st) 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.

Trial Registration:

Clinical Trials: NCT02580214.

Citing Articles

A systematic review and meta-analysis of preoperative carbohydrate drink loading prior to elective hip and knee arthroplasty.

Pradhan A, Srinivasan A, Raj S, Howard D, Aujla R J Clin Orthop Trauma. 2025; 63:102928.

PMID: 40061219 PMC: 11889337. DOI: 10.1016/j.jcot.2025.102928.

Improved outcomes with perioperative dietitian-led interventions in patients undergoing total joint arthroplasty: A systematic review.

Yee S, Schmidt R, Satalich J, Krumme J, Golladay G, Patel N J Orthop. 2024; 56:12-17.

PMID: 38737733 PMC: 11081787. DOI: 10.1016/j.jor.2024.04.021.

Immunonutrition in Orthopedic and Traumatic Patients.

Gregori P, Franceschetti E, Basciani S, Impieri L, Zampogna B, Matano A Nutrients. 2023; 15(3).

PMID: 36771245 PMC: 9919811. DOI: 10.3390/nu15030537.

Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection.

Li Z, Maimaiti Z, Li Z, Fu J, Hao L, Xu C Nutrients. 2022; 14(20).

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Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty: a Detailed Review and Guide to Management.

Dube M, Rothfusz C, Emara A, Hadad M, Surace P, Krebs V Curr Rev Musculoskelet Med. 2022; 15(4):311-322.

PMID: 35501548 PMC: 9276913. DOI: 10.1007/s12178-022-09762-7.

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