Amino Acid Supplementation Is Associated with Reduced Mortality and Complications Following Acute Fracture Fixation: Results of a Prospective, Randomized Controlled Trial

Abstract

Abstract Objectives Acute musculoskeletal trauma patients experience immobilization and under-nutrition resulting in catabolic skeletal muscle wasting and compromised wound healing. We conducted a prospective RCT to assess the effect of supplementation with conditionally essential amino acids (CEAA) on postoperative outcomes in patients with acute orthopedic trauma. We hypothesized that supplementation with CEAA would decrease postoperative complications. Methods Adults with operative pelvis or long bone fractures, excluding distal radius fractures, were prospectively enrolled in this single-blinded RCT. Patients were assigned by stratified by injury severity and randomized to standard preoperative nutrition (control) or standard nutrition with oral supplement containing CEAA for two weeks after surgery (CEAA). Subjects with minimum 6-months follow up were included in this analysis. Postoperative complication rates were analyzed with X,2 using intention-to-treat analysis. Results 243 patients met inclusion criteria (Control: 117, CEAA: 126). Median supplement compliance in CEAA patients was 84% of 28 prescribed CEAA servings with no reported supplement-related adverse events. 7 of 117 patients within the control group died during follow up vs. 1 of 126 in CEAA group (P = 0.031). Total complication rate was 55% control patients and 41% CEAA patients (P = 0.040). Surgical site infection (SSI) rates were 24% in control vs. 14% in CEAA (P = 0.055). Medical complication rates were 35% in control vs. 23% in CEAA (P = 0.039). Nonunion rates were 3% in control vs. 5% in CEAA (P = 0.751). Conclusions Patients receiving CEAA supplementation following acute fracture fixation had significantly lower mortality, overall complications, and medical complications. There was a trend toward decreased surgical site infections among patients receiving CEAA, although this did not reach statistical significance. Postoperative oral supplementation with CEAA is a low-cost, low-risk intervention associated with reductions in postoperative mortality and complications. Further work is warranted to improve preoperative risk stratification and further define which individuals receive greatest benefit from this intervention. Funding Sources American Academy of Orthopaedic Surgeons, Board of Specialty Societies Quality and Patient Safety Action Fund.