Abstract
BackgroundOral or enteral dietary supplementation with arginine, omega 3 fatty acids and nucleotides (known as immunonutrition) significantly improve outcomes in patients undergoing elective surgery. The objective of the study was to determine the impact on hospital costs of immunonutrition formulas used in patients undergoing elective surgery for gastrointestinal cancer.MethodsUS hospital costs of stay with and without surgical infectious complications, and average cost per day in the hospital for patients undergoing elective surgery for gastrointestinal cancer were estimated using data from the Healthcare Cost and Utilization Project’s 2008 Nationwide Inpatient Sample. These costs were then used to estimate the impact of perioperative immunonutrition on hospital costs using estimates of reduction in infectious complications or length of stay from a meta-analysis of clinical trials in patients undergoing elective surgery for gastrointestinal cancer. Sensitivity of the results to changes in baseline complication rates or length of stay was tested.ResultsFrom the meta-analysis estimates, use of immunonutrition resulted in savings per patient of $3,300 with costs based on reduction in infectious complication rates or $6,000 with costs based on length of hospital stay. Cost savings per patient were present for baseline complication rates above 3.5% or when baseline length of stay and infectious complication rates were reduced to reflect recent US data for those with upper and lower GI elective cancer surgery (range, $1,200 to $6,300).ConclusionsUse of immunonutrition for patients undergoing elective surgery for gastrointestinal cancer is an effective and cost-saving intervention.
Highlights
IntroductionOral or enteral dietary supplementation with arginine, omega 3 fatty acids and nucleotides (known as immunonutrition) significantly improve outcomes in patients undergoing elective surgery
Oral or enteral dietary supplementation with arginine, omega 3 fatty acids and nucleotides significantly improve outcomes in patients undergoing elective surgery
Immunonutrition has been studied in multiple clinical trials, consistently showing reduced postsurgical infectious complications, and some studies showing a decrease in selected noninfectious complications in patients undergoing elective surgery, including patients undergoing elective surgical interventions for gastrointestinal cancer
Summary
Oral or enteral dietary supplementation with arginine, omega 3 fatty acids and nucleotides (known as immunonutrition) significantly improve outcomes in patients undergoing elective surgery. Infectious and other types of complications following gastrointestinal cancer, head and neck cancer, and cardiac surgery are frequent and add significantly to patient morbidity as well as to hospital length of stay and costs [1,2]. Waitzberg and colleagues [4] examined the relationship between hospital length of stay or postoperative infectious complications or anastomotic leak, a noninfectious complication, and the use of immunonutrition using a nutritionally complete formula containing supraphysiologic quantities of arginine, omega-3 fatty acids, and nucleotides (IMPACTW, Nestlé Science Health, Vevey, Switzerland). The results of the Waitzberg meta-analysis showed that, for all nutrition intervention strategies and for all surgical patients studied, use of immunonutrition resulted in lower postsurgical infectious complications, a lower rate of anastomotic leak, and shorter length of stay
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