Major surgery induces traumatic stress due to the surgical aggression which could lead to
major postoperative complications and death when the patient organism is not ready or
prepared to support this intense stress. Malnutrition can be caused by chronic
starvation, chronic inflammatory disease and acute injury (stress, acute inflammation).
Therefore, nutritional supplements are indicated for patients who do not meet their
energy needs through oral food ingestion. Immune-modulating nutrient-enriched products
containing arginine, Omega-3 polyunsaturated fatty acids (PUFAs), nucleic acids, vitamins
and antioxidants (selenium) like ORAL IMPACT (Nestlé) can modulate immune and
inflammatory processes in burn, trauma, major surgery and improving clinical outcomes.
These immune-modulating nutrient-enriched products have shown their ability to decrease
postoperative complications up to 50% in patients undergoing non-gastrointestinal major
surgery and length of hospital and ICU stay (Jie B 2012, Drover 2011). Mortality benefits
have been demonstrated in one study focused on Neck and Head surgery. (Buijs N, 2010)
Before 2019, in our urology surgery setting, it seemed that the postoperative
complications rate was clinically increasing despite reliable surgeons and excellent
surgery techniques and procedures. It appeared that the sources of these complications
might be the weakness of the patients against major surgical stress. Patients might have
been malnourished. The nutritional status had been omitted from our preoperative
anesthesia assessment and no perioperative nutritional rehabilitation had been performed.
The effect of immune-modulating nutrient-enriched products had been demonstrated mostly
in gastrointestinal surgery but also in non-gastrointestinal surgeries such as neck and
head cancer surgery, gynecologic cancer surgery and cardiac surgery. There are not
studies conducted in urologic major surgery.
Reducing the number of post-operative complications is a major challenge in surgery
because they cause an increase in the length of stay, which translates into higher
hospital costs for the community. Surgery generates major metabolic stress that the human
body must manage. This metabolic stress will manifest itself in an increase in catabolism
and a decrease in anabolism, resulting in protein-energy malnutrition in the patient if
they are insufficiently prepared. Preoperative undernutrition is one of the risk factors
for major postoperative complications.
Moreover, postoperative infection can occur despite the Oral Impact treatment and
associated iron and protein-caloric rehabilitation. It is linked to postoperative
hypoalbuminemia. The antimicrobial role of albumin in the body is significant due to its
antioxidant power. Reduced, non-oxidized albumin is the primary antioxidant in the body.
Postoperative inflammation consumes reduced albumin, thereby diminishing the body's
antioxidant capacity and exposing it to complications and nosocomial infections. The
exogenous supply of reduced albumin is therefore indispensable. The liver's albumin
synthesis yield is too low in this inflammatory context, amounting to approximately one
vial of 20% albumin per day. Preoperatively, the correction of any hypoalbuminemia is
anticipated through the nutritional rehabilitation implemented with the dietitian team.
The timing of the surgery does not always allow the body to correct this hypoalbuminemia
on its own. It is also essential to correct it postoperatively, in case of complications
if necessary, through the exogenous supply of 20% reduced albumin.
Numerous studies have shown the benefit of perioperative Oral Impact immunomodulation in
gastrointestinal surgery, ear, nose and throat surgery, gynecological and cardiac
surgery.
No studies have been done in major Urological surgery The proposed study will be the
first formal evaluation of the benefits and risks of using ORAL IMPACT in the
preoperative period of urological surgery. The choice of this clinical project for this
research question is justified by the proven benefit of this food substitute
perioperatively in gastrointestinal, ear, nose and throat, gynecological and cardiac
surgery. We hypothesize that Oral Impact will protect against major postoperative
complications and prolonged hospital stay for patients undergoing urological surgery.
There are no current guidelines recommending or discouraging the prescription of ORAL
IMPACT in urological surgery patients.