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Effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of two randomized clinical trials

BACKGROUND: The effect of early achievement of energy targets (EAETs) using different nutritional support strategies in patients undergoing major abdominal surgery is unclear. This study determined the impact of EAETs on the incidence of nosocomial infections in patients undergoing major abdominal s...

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Autores principales: Gao, Xuejin, Zhang, Li, Zhang, Yupeng, Zhou, Da, Gao, Tingting, Liu, Yuxiu, Jin, Gang, Wang, Kunhua, Zhou, Yanbing, Chi, Qiang, Yang, Hua, Li, Mengbin, Yu, Jianchun, Qin, Huanlong, Tang, Yun, Wu, Xiaoting, Li, Guoli, Wang, Xinying
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498879/
https://www.ncbi.nlm.nih.gov/pubmed/37300882
http://dx.doi.org/10.1097/JS9.0000000000000526
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author Gao, Xuejin
Zhang, Li
Zhang, Yupeng
Zhou, Da
Gao, Tingting
Liu, Yuxiu
Jin, Gang
Wang, Kunhua
Zhou, Yanbing
Chi, Qiang
Yang, Hua
Li, Mengbin
Yu, Jianchun
Qin, Huanlong
Tang, Yun
Wu, Xiaoting
Li, Guoli
Wang, Xinying
author_facet Gao, Xuejin
Zhang, Li
Zhang, Yupeng
Zhou, Da
Gao, Tingting
Liu, Yuxiu
Jin, Gang
Wang, Kunhua
Zhou, Yanbing
Chi, Qiang
Yang, Hua
Li, Mengbin
Yu, Jianchun
Qin, Huanlong
Tang, Yun
Wu, Xiaoting
Li, Guoli
Wang, Xinying
author_sort Gao, Xuejin
collection PubMed
description BACKGROUND: The effect of early achievement of energy targets (EAETs) using different nutritional support strategies in patients undergoing major abdominal surgery is unclear. This study determined the impact of EAETs on the incidence of nosocomial infections in patients undergoing major abdominal surgery. METHODS: This was a secondary analysis of two open-label randomized clinical trials. Patients from the general surgery department of 11 academic hospitals in China undergoing major abdominal surgery and at nutritional risk (Nutritional risk screening 2002≥3) were divided into two groups based on whether they met the 70% energy targets, the EAET (521 EAET and non-achievement of energy target (114 NAET) groups. The primary outcome was the incidence of nosocomial infections between postoperative day 3 and discharge, and the secondary outcomes were actual energy and protein intake, postoperative noninfectious complications, intensive care unit admission, mechanical ventilation, and hospital stay. RESULTS: Overall, 635 patients [mean (SD) age, 59.5 (11.3) years] were included. The EAET group received more mean energy between days 3 and 7 than the NAET group (22.7±5.0 vs. 15.1±4.8 kcal/kg/d; P<0.001). The EAET group had significantly fewer nosocomial infections than the NAET group [46/521(8.8%) vs. 21/114(18.4%); risk difference, 9.6%; 95% CI, 2.1–17.1%; P=0.004]. A significant difference was found in the mean (SD) number of noninfectious complications between the EAET and NAET groups [121/521(23.2%) vs. 38/114(33.3%); risk difference, 10.1%; 95% CI, 0.7–19.5%; P=0.024]. The nutritional status of the EAET group was significantly improved at discharge compared with the NAET group (P<0.001), and other indicators were comparable between groups. CONCLUSION: EAETs was associated with fewer nosocomial infections and improved clinical outcomes, regardless of the nutritional support strategy (early enteral nutrition alone or combined with early supplemental parenteral nutrition).
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spelling pubmed-104988792023-09-14 Effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of two randomized clinical trials Gao, Xuejin Zhang, Li Zhang, Yupeng Zhou, Da Gao, Tingting Liu, Yuxiu Jin, Gang Wang, Kunhua Zhou, Yanbing Chi, Qiang Yang, Hua Li, Mengbin Yu, Jianchun Qin, Huanlong Tang, Yun Wu, Xiaoting Li, Guoli Wang, Xinying Int J Surg Original Research BACKGROUND: The effect of early achievement of energy targets (EAETs) using different nutritional support strategies in patients undergoing major abdominal surgery is unclear. This study determined the impact of EAETs on the incidence of nosocomial infections in patients undergoing major abdominal surgery. METHODS: This was a secondary analysis of two open-label randomized clinical trials. Patients from the general surgery department of 11 academic hospitals in China undergoing major abdominal surgery and at nutritional risk (Nutritional risk screening 2002≥3) were divided into two groups based on whether they met the 70% energy targets, the EAET (521 EAET and non-achievement of energy target (114 NAET) groups. The primary outcome was the incidence of nosocomial infections between postoperative day 3 and discharge, and the secondary outcomes were actual energy and protein intake, postoperative noninfectious complications, intensive care unit admission, mechanical ventilation, and hospital stay. RESULTS: Overall, 635 patients [mean (SD) age, 59.5 (11.3) years] were included. The EAET group received more mean energy between days 3 and 7 than the NAET group (22.7±5.0 vs. 15.1±4.8 kcal/kg/d; P<0.001). The EAET group had significantly fewer nosocomial infections than the NAET group [46/521(8.8%) vs. 21/114(18.4%); risk difference, 9.6%; 95% CI, 2.1–17.1%; P=0.004]. A significant difference was found in the mean (SD) number of noninfectious complications between the EAET and NAET groups [121/521(23.2%) vs. 38/114(33.3%); risk difference, 10.1%; 95% CI, 0.7–19.5%; P=0.024]. The nutritional status of the EAET group was significantly improved at discharge compared with the NAET group (P<0.001), and other indicators were comparable between groups. CONCLUSION: EAETs was associated with fewer nosocomial infections and improved clinical outcomes, regardless of the nutritional support strategy (early enteral nutrition alone or combined with early supplemental parenteral nutrition). Lippincott Williams & Wilkins 2023-06-07 /pmc/articles/PMC10498879/ /pubmed/37300882 http://dx.doi.org/10.1097/JS9.0000000000000526 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Original Research
Gao, Xuejin
Zhang, Li
Zhang, Yupeng
Zhou, Da
Gao, Tingting
Liu, Yuxiu
Jin, Gang
Wang, Kunhua
Zhou, Yanbing
Chi, Qiang
Yang, Hua
Li, Mengbin
Yu, Jianchun
Qin, Huanlong
Tang, Yun
Wu, Xiaoting
Li, Guoli
Wang, Xinying
Effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of two randomized clinical trials
title Effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of two randomized clinical trials
title_full Effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of two randomized clinical trials
title_fullStr Effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of two randomized clinical trials
title_full_unstemmed Effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of two randomized clinical trials
title_short Effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of two randomized clinical trials
title_sort effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of two randomized clinical trials
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498879/
https://www.ncbi.nlm.nih.gov/pubmed/37300882
http://dx.doi.org/10.1097/JS9.0000000000000526
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