World Journal of Surgery

, Volume 30, Issue 8, pp 1592–1604 | Cite as

Postsurgical Infections are Reduced with Specialized Nutrition Support

  • Dan L. WaitzbergEmail author
  • Hideaki Saito
  • Lindsay D. Plank
  • Glyn G. Jamieson
  • Palepu Jagannath
  • Tsann-Long Hwang
  • Juan M. Mijares
  • David Bihari



The objective was to examine the relationship between pre-, peri-, and postoperative specialized nutritional support with immune-modulating nutrients and postoperative morbidity in patients undergoing elective surgery.


Studies were identified by searching MEDLINE, review article bibliographies, and abstracts and proceedings of scientific meetings. All randomized clinical trials in which patients were supplemented by the IMPACT formula before and/or after elective surgery and the clinical outcomes reported were included in the meta-analysis. Seventeen studies (n = 2,305), 14 published (n = 2,102), and 3 unpublished (n = 203), fulfilled the inclusion criteria. Ten studies (n = 1,392) examined the efficacy of pre- or perioperative IMPACT supplementation in patients undergoing elective surgery, whereas 7 (n = 913) assessed postoperative efficacy. Fourteen of the studies (n = 2,083) involved gastrointestinal (GI) surgical patients. Postoperative complications, mortality, and length of stay in hospital (LOS) were major outcomes of interest.


IMPACT supplementation, in general, was associated with significant (39%–61%) reductions in postoperative infectious complications and a significant decrease in LOS in hospital by an average of 2 days. The greatest improvement in postoperative outcomes was observed in patients receiving specialized nutrition support as part of their preoperative treatment. In GI surgical patients, anastomotic leaks were 46% less prevalent when IMPACT supplementation was part of the preoperative treatment.


This study identifies a dosage (0.5–1 l/day) and duration (supplementation for 5–7 days before surgery) of IMPACT that contributes to improved outcomes of morbidity in elective surgery patients, particularly those undergoing GI surgical procedures. The cost effectiveness of such practice is supported by recent health economic analysis. Findings suggest preoperative IMPACT use for the prophylaxis of postoperative complications in elective surgical patients.


Relative Risk Anastomotic Leak Infectious Complication Abdominal Abscess Postoperative Infectious Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The hypothesis for this investigation was conceived at a workshop attended by leading practitioners from Asian Pacific and Latin American regions and co-chaired by Drs. Waitzberg and Saito. The authors gratefully acknowledge Novartis Medical Nutrition, Nyon Switzerland, for sponsoring the workshop, and Dr. Heinz Schneider of HealthEcon, Health Service Consultants, Basel, Switzerland, for organizing the event. We also thank Dr. T. Grunberger, Dr. R. Tepaske, and Dr. L. Krahenbuhl for supplying outcome data prior to their publication; A. Schmid for data accrual; and Dr. C. Galani for statistical support.


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Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Dan L. Waitzberg
    • 1
    Email author
  • Hideaki Saito
    • 2
  • Lindsay D. Plank
    • 3
  • Glyn G. Jamieson
    • 4
  • Palepu Jagannath
    • 5
  • Tsann-Long Hwang
    • 6
  • Juan M. Mijares
    • 7
  • David Bihari
    • 8
  1. 1.Department of Gastroenterology, LIM 35University of São Paulo Medical SchoolSao PauloBrazil
  2. 2.Departments of SurgeryUniversity of TokyoTokyoJapan
  3. 3.University of AucklandAucklandNew Zealand
  4. 4.University of AdelaideAdelaideAustralia
  5. 5.Lilavati HospitalMumbaiIndia
  6. 6.Chang Gung UniversityTaipeiTaiwan
  7. 7.University of AnáhuacMexico CityMexico
  8. 8.Department of Intensive CarePrince of Wales HospitalSydneyAustralia

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