The effect of pre-operative oral immunonutrition therapy on postoperative outcomes in gastrointestinal surgery patients.

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It is well known that major surgery causes a decrease in immune function, which in turn can lead to an increased rate of post operative inflammation and infection. Recently, research has been focused on the role of pre-operative oral immune enhancing nutrition and its positive influences on inflammation, metabolism and immune responses after surgery. The positive effects shown in recent studies have also been linked to a decreased in length of hospital stay and substantially reduced treatment costs. Given the strong support in medical literature, the Departments of Surgery and Clinical Nutrition wish to examine the effect of Impact Advanced Recovery (Novartis Nutrition Corporation, United States of America) on major upper and lower bowel surgery patients. Eligible patients (all patients undergoing upper and lower bowel surgery at The Royal Melbourne Hospital - excluding patients who are inmmunosupressed, have chronic infections, hepatic disease or renal failure), will be randomized into one of two groups, treatment or control. The treatment group will receive Impact Advanced Recovery (237ml packs) three times a day for the five days leading up to surgery. The control group will receive no nutritional supplements, which is in line with current treatment. After their operation, patients will receive normal clinical care as per their managing surgical team. Outcome measures such as length of hospital stay, infection rate, non-infective complications, unexpected ICU admission and death will be measured by means of direct data collection from medical charts during the patients admission. A statistical analysis using an unpaired t-test and Fisher's exact test will be performed on the data. We hope this trial will support the need for The Royal Melbourne Hospital to provide immune enhancing nutritional supplements to patients prior to major upper and lower bowel surgery patients.

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