Impact of Preoperative Immunonutrition on Outcomes of Immediate Breast Reconstruction

BACKGROUND: Recent literature in various surgical specialties has shown the use of enteral immunonutrition prior to major surgery to reduce infectious complications, length of stay, and overall morbidity.1,2 To date, no studies have examined the use of immunonutrition within plastic and reconstructive surgery. The purpose of this study is to evaluate the impact of preoperative immunonutrition supplementation on the outcomes of immediate breast reconstruction. METHODS: All patients undergoing immediate autologous or alloplastic breast reconstruction at the University of Wisconsin, Madison beginning February 2018 were contacted and offered enrollment in this study. All patients who consumed Impact Advanced Recovery for 5 days before the surgery were reviewed (n = 59: 36 autologous, 23 alloplastic). This group was compared with a retrospective control group (n = 106: 40 autologous, 66 alloplastic) of patients who underwent surgery before February 2018. No other major changes in perioperative care or operative technique were made within the timeframe of the retrospective or prospective collection period. Chart review was performed on all patients in a 30-day (autologous, direct-to-implant) or 90-day (expander) postoperative window. The rates of surgical site infection, wound dehiscence, seroma, and mastectomy skin flap necrosis were analyzed individually and combined to form an aggregate “wound complication rate.” RESULTS: Aggregate wound complication rate was reduced from 49.06% to 32.20% after intervention (P = 0.0361). Specifically, the rate of mastectomy skin flap necrosis was reduced from 24.53% to 8.47% (P = 0.0114), and the rate of wound dehiscence was reduced from 15.09% to 1.69% (P = 0.0067) in the cohort who received preoperative immunonutrition supplementation. The rates of infection, unplanned return to the operating room, and aborted reconstruction were not significantly different between the control and interventional cohorts. CONCLUSIONS: Based on the initial results of this ongoing trial, preoperative immunonutrition supplementation with Impact Advanced Recovery may significantly improve wound complication rate in patients undergoing immediate autologous and alloplastic breast reconstruction. REFERENCES: 1. Hegazi RA, Hustead DS, Evans DC. Preoperative standard oral nutrition supplements vs immunonutrition: results of a systematic review and meta-analysis. J Am Coll Surgeons. 2014;219:1078–1087. 2. Xu J, Sun X, Xin Q, et al. Effect of immunonutrition on colorectal cancer patients undergoing surgery: a meta-analysis. Int J Colorectal Dis. 2018;33:273–283.

Abstract licence: CC BY-NC-ND

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