Research Appendix
The Role of Amino Acid Supplementation in Orthopedic Surgery - published in JAAOS 2.15.24
The nutritional status of patients undergoing orthopaedic surgery has started to garner increasing attention in published literature. Notable previous evidence has demonstrated the negative effect of malnutrition on outcomes after orthopaedic procedures. Although there has been increased recognition of malnutrition as a risk factor for suboptimal outcomes, the use of nutritional supplementation to mitigate those risks is not well understood. The purpose of this review of most current literature on the topic is to introduce and elucidate the role of amino acid supplementation as a countermeasure to muscle loss and improvement of nutritional status in orthopedic patients to improve results and outcomes after orthopedic surgery
Nutrition in Surgery: An Orthopedic Perspective - pay wall click here for summary
A comprehensive review from the Journal of Bone and Joint Surgery provides crucial insights on the role of nutrition in orthopedic surgery. The study, led by experts including Joseph J. Kavolus, MD, Thomas M. Zink, MD, and Suzanne E. Kent, MD, reveals key findings:
Perioperative Nutritional Support: A Review of Current Literature
Read a detailed review of perioperative nutritional support, emphasizing its importance in improving surgical outcomes and reducing postoperative complications. The review discusses the role of malnutrition in postoperative recovery, the impact of perioperative nutritional support on reducing infectious complications, the need for intensive care unit (ICU) and hospital stay, costs, and mortality, and the latest developments and available literature in this field. It also covers the mechanisms related to the disease that indicates the need for surgical intervention, mechanisms related to the surgical act, and available guidelines from the European Society for Parenteral and Enteral Nutrition (ESPEN) and the ERAS Society.
ESPEN practical guideline: Clinical nutrition in surgery
The study provides valuable insights into the use of enteral and parenteral nutrition in surgical patients, including the circumstances in which PN may be beneficial. It also highlights the benefits of EN over PN in certain aspects.
More coming soon. Reach out to info@imtuitve.com to learn more about how imtuitive can help you recover with a peace of mind.
Nutrition in Surgery: An Orthopedic Perspective
Joseph J. Kavous, MD | Thomas M. Zink, MD | Suzanne E. Kent, MD | Arjun N. Choudhary, BA
Link to the full study on THE JOURNAL OF BONE AND JOINT SURGERY (JB&JS) (noted this is behind a paywall, for a summary and key insight read below)
Current Insights on Nutrition in Orthopedic Surgery
A comprehensive review from the Journal of Bone and Joint Surgery provides crucial insights on the role of nutrition in orthopedic surgery. The study, led by experts including Joseph J. Kavolus, MD, Thomas M. Zink, MD, and Suzanne E. Kent, MD, reveals key findings:
Malnutrition and Orthopedic Surgery
Prevalence: Malnutrition is common in patients undergoing orthopedic surgery, particularly among the elderly and those with orthopedic trauma.
Risks: Malnutrition is linked to increased risks of postoperative complications like wound-healing issues, infections, and even mortality.
Evaluating Nutritional Status
Serologic Markers: Albumin, prealbumin, transferrin, and total lymphocyte count are used to assess nutritional status.
Anthropometric Measures: Body mass index (BMI), calf circumference, and triceps fold size offer additional perspectives on a patient's nutritional health.
Nutritional Intervention Strategies
Supplementation Needs: Increased caloric and protein intake is recommended during the perioperative period.
Types of Supplements: Protein-calorie, amino acid, and immunonutrition supplements are beneficial, with vitamin D supplementation as an area for further study.
Addressing Obesity and Weight Loss
Obesity Risks: Obesity is associated with higher perioperative complications.
Weight Loss Approaches: Diet restriction, physical activity, pharmacotherapy, and bariatric surgery are effective but require careful management to avoid nutritional deficits.
Key Recommendations
The review advocates for preoperative nutritional evaluation using laboratory tests, anthropometric measures, and screening tools.
It emphasizes the need for protein supplementation and recommends including vitamin D supplementation.
A holistic approach involving dieticians and personalized care plans is suggested for high-risk patients.
This study underscores the critical role of nutrition in orthopedic surgery, advocating for a more comprehensive approach to patient care and highlighting the need for ongoing research and innovation in this area.
Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and MuscleWasting After Fracture Fixation
This blog summarizes a significant study from the University of Iowa's Department of Orthopedics & Rehabilitation, led by Nathan R. Hendrickson, MD, and his team. The study, a randomized controlled trial, investigates the effects of amino acid supplementation on reducing postoperative complications and preserving muscle mass in patients with acute fractures. The findings highlight the potential of this low-risk intervention in improving recovery outcomes, paving the way for more extensive research in trauma care.
A Randomized Controlled Trial
Nathan R. Hendrickson, MD, John Davison, MPH, Natalie A. Glass, PhD, Erin S. Wilson, MD, Aspen Miller, BS, Steven Leary, MA, William Lorentzen, BS, Matthew D. Karam, MD, Matthew Hogue, MD, J. Lawrence Marsh, MD, and Michael C. Willey, MD
Investigation performed at the Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, Iowa
Background: Postoperative complications and substantial loss of physical function are common after musculoskeletal trauma. We conducted a prospective randomized controlled trial to assess the impact of conditionally essential amino acid (CEAA) supplementation on complications and skeletal muscle mass in adults after operative fixation of acute fractures.
Methods: Adultswhosustainedpelvicandextremityfracturesthatwereindicatedforoperativefixationatalevel-Itrauma center were enrolled. The subjects were stratified based on injury characteristics (open fractures and/or polytrauma, fragility fractures, isolated injuries) and randomized to standard nutrition (control group) or oral CEAA supplementation twice daily for 2 weeks. Body composition (fat-free mass [FFM]) was measured at baseline and at 6 and 12 weeks postoperatively. Complications were prospectively collected. An intention-to-treat analysis was performed. The relative risk (RR) of complications for the control group relative to the CEAA group was determined, and linear mixed-effects models were used to model the relationship between CEAA supplementation and changes in FFM.
Results: Four hundred subjects (control group: 200; CEAA group: 200) were enrolled. The CEAA group had significantly lower overall complications than the control group (30.5% vs. 43.8%; adjusted RR = 0.71; 95% confidence interval [CI] = 0.55 to 0.92; p = 0.008). The FFM decreased significantly at 6 weeks in the control subjects (–0.9 kg, p = 0.0205), whereas the FFM was maintained at 6 weeks in the CEAA subjects (20.33 kg, p = 0.3606). This difference in FFM was not seen at subsequent time points.
Conclusions: Our results indicate that CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. Given the potential benefits of this inexpensive, low-risk intervention, multicenter prospective studies in focused trauma populations are warranted.