Postoperative enteral immunonutrition in head and neck cancer patients: Impact on clinical outcomes.

BACKGROUND: Head and neck cancer patients have a high rate of complications during the postoperative period that could increase their morbidity rate. Arginine has been shown to improve healing and to modulate inflammation and immune response. The aim of our study was to assess whether use of arginine-enriched enteral formulas could decrease fistulas and length of stay (LoS). METHODS: A retrospective study was conducted in patients who had undergone head and neck cancer surgery and were receiving enteral nutrition through a nasogastric tube in the postoperative period between January 2012 and May 2018. The differences associated to use of immunoformula vs. standard formulas were analysed. Sociodemographic, anthropometric, and nutritional intervention variables, as well as nutritional parameters, were recorded during the early postoperative period. Occurrence of complications (fistulas), length of hospital stay, readmissions, and 90-day mortality were recorded. RESULTS: In a univariate analysis, patients who received nutritional support with immunonutrition had a lower fistula occurrence rate (17.91% vs. 32.84%; p=0.047) and a shorter mean LoS [28.25 (SD 16.11) vs. 35.50 (SD 25.73) days; p=0.030]. After adjusting for age, energy intake, aggressiveness of surgery and tumour stage, fistula occurrence rate and LoS were similar in both groups irrespective of the type of formula. CONCLUSIONS: Use of arginine-enriched enteral nutrition appears to decrease the occurrence of fistulas in the postoperative period in patients with head and neck cancer, with a resultant reduction in length of hospital stay. However, the differences disappeared after adjusting for age, tumour stage, or aggressiveness of the surgery.

The appearance of malnutrition in hematological inpatients prolongs hospital stay: the need for nutritional surveillance during hospitalization.

INTRODUCTION: Introduction: oncohematological diseases are associated with a high prevalence of malnutrition during hospitalization. Our aim was to analyze the appearance and repercussions of malnutrition in well-nourished hematological inpatients at admission. Method: a prospective one-year study conducted in hematology inpatients. The Malnutrition Screening Tool (MST) was used at admission and repeated weekly. Patients with a negative screening at admission who developed malnutrition during hospitalization constituted our study sample. A nutritional evaluation and intervention was performed. We also analyzed the effect of newly diagnosed malnutrition on patients' outcomes in comparison with the outcomes of patients that remained well-nourished during hospitalization. Results: twenty-one percent of hematological inpatients who were well nourished at admission developed malnutrition during hospitalization. Of the patients, 62.4% needed a nutritional intervention (100% oral supplements, 21.4% diet changes, 5.2% parenteral nutrition). After intervention, an increase in real intake was achieved (623 kcal and 27.3 g of protein/day). Weight loss was slowed and visceral protein was stabilized. Length of stay was 8.5 days longer for our sample than for well-nourished patients. Conclusions: newly diagnosed malnutrition appeared in one in five hematological well-nourished inpatients, leading to a longer length of stay. Nutritional intervention improved intake and nutritional status. Nutritional surveillance should be mandatory.

INTRODUCCIÓN: Introducción: las enfermedades oncohematológicas asocian una elevada prevalencia de malnutrición, especialmente durante la hospitalización. Objetivo: analizar la aparición de malnutrición y su repercusión en pacientes normonutridos al ingreso. Métodos: estudio prospectivo de un año en una cohorte de ingresados hematológicos. El Malnutrition Screening Tool (MST) se realizó al ingreso, repitiéndose semanalmente. Los pacientes con cribado negativo al ingreso que desarrollaron malnutrición durante la hospitalización constituyeron nuestra muestra. Se realizó evaluación e intervención nutricional, analizando el efecto de la aparición de malnutrición en el pronóstico, comparado con los pacientes que permanecieron normonutridos. Resultados: el 21% de los pacientes normonutridos al ingreso desarrolló malnutrición en la hospitalización. El 62.4% precisó intervención nutricional (100% suplementos orales, 21,4% cambios dietéticos, 5.2% nutrición parenteral). La intervención logró un aumento de ingesta real de 623 kcal y 27,3 g proteína/día, frenando la pérdida de peso y estabilizando las proteínas viscerales. La estancia fue 8,5 días mayor en nuestra muestra que en los pacientes que permanecieron normonutridos. Conclusiones: uno de cada cinco ingresados normonutridos al ingreso desarrolló malnutrición en la hospitalización, asociando mayor estancia. La intervención nutricional puede mejorar la ingesta y el estado nutricional, por tanto, la vigilancia nutricional debería ser obligatoria.