Gebruik van antioxidanten en immunonutritie voor chirurgie

Gebruik van antioxidanten voor majeure abdominale chirurgie en hoofd/hals chirurgie; gebruik van immunonutritie en antioxidanten voor ‘overige’ chirurgie.

Er werden geen systematische reviews gevonden die aan de volgende inclusiecriteria voldeden: (1) systematische reviews met meta-analyse van gerandomiseerde studies, (2) met GRADE-beoordeling van de mate van zekerheid van de effectgroottes in relatie tot de voedingsstatus (‘ondervoed’, ‘goed gevoed’, (3) met analyse van type immunonutritie, en (4) met aandacht voor publicatiebias:

Om toch een overzicht te bieden van het effect van immunonutritie en antioxidanten van ‘overige’ chirurgie van de afgelopen 10 jaar is gekeken over welk type chirurgie het meest is gerapporteerd. Dat is de hartchirurgie.

 

Reference [preoperative/postoperative use of nutrient]

Outcomes

 

Outcome atrial fibrillation

Acute kidney injury

Mortality

Postoperative complications

Length of stay (LOS)

Antioxidants in cardiac surgery

Ali- Hasan- Al- Saegh, S., et al. (2016) [?]

N-acetylcysteine (NAC) (OR=0.5; P=.001), vitamin C (OR=0.4; P=.001)

Only NAC: (OR=0.7; P=.01)

NAC: (OR=0.3; P=.03)

 

 

Baker, W. L. and C. I. Coleman (2016) [preoperative and/or postoperative use]

Vitamin C: odds ratio, 0.44; 95% confidence interval [CI], 0.32 to 0.61

 

 

 

(ICU) LOS (difference in means, -0.24 day; 95% CI, -0.45 to -0.03 day), and total hospital LOS (difference in means, -0.94 day; 95% CI, -1.65 to -0.23 day

Geng, J., et al. (2017) [preoperative and/or postoperative use]

Antioxidant vitamins: relative risk: 0.55, 95% CI 0.42, 0.73, P < 0.0001)

 

 

Relative risk: 0.72, 95% CI 0.48, 1.08, P = 0.11

Difference in means: -0.68 day, 95% CI -0.98, -0.39, P < 0.00001

Guo, X. Y., et al. (2014

[preoperative and/or postoperative use])

Combination therapy with PUFA and vitamins C and E: OR: 0.32; 95%CI: 0.17-0.60; P=0.0005

 

 

 

 

Hemila, H. and T. Suonsyrja (2017)[preoperative and/or postoperative use]

Vitamin C: In trials carried out in the USA: RR = 1.04 (95% CI: 0.86-1.27). In trials conducted outside of the USA: RR = 0.56 (95% CI: 0.47-0.67).

 

 

 

 

Hill, A., et al. (2019) [preoperative and/or postoperative use]

Vitamin C: decreased the incidence of atrial fibrillation (p = 0.008)

 

no significant effects on in-hospital mortality (p = 0.76)

 

decreased ICU length-of-stay (p = 0.004), and hospital length-of-stay (p < 0.0001)

Putzu, A., et al. (2019) [preoperative and/or postoperative use]

Vitamin C: relative risk: 0.64; 95% CI, 0..52 - 0.78; p < 0.0001)

 

 

 

ICU LOS: standardized mean difference, -0.28 day; 95% CI, -0.43 to -0.13 d; p = 0.0003

Hospital LOS: standardized mean difference, -0.30 d; 95% CI, -0.49 to -0.10 d; p = 0.002

Shi, R., et al. (2018) [preoperative and postoperative use]

Vitamin C: relative risk: 0.68, 95% confidence interval [CI]: 0.54 to 0.87, P = 0.002

 

 

 

ICU LOS: difference in means: -0.24 days, 95% CI: -0.45 to -0.03, P = 0.023),

hospital LOS: difference in means: -0.95 days, 95% CI: -1.64 to -0.26, P = 0.007),

Conclusion per outcome measure, by Dutch guideline panel on perioperative nutritional support

Most systematic reviews on vitamin C (or combined with E) use show an appreciable decreased risk of atrial fibrillation

One systematic review on NAC use shows an appreciable decreased risk of acute kidney injury

Systematic reviews on antioxidants use show conflicting results

One systematic review on antioxidant vita-mins shows an uncertain reduction in risk of postoperative complications

Most systematic reviews show a LOS reduction of less than one day, which is of questionable relevance.

Immunonutrients in cardiac surgery

Ali- Hasan- Al- Saegh, S., et al. (2016)[?]

PUFA (OR=0.8; P=.01)

 

 

 

 

Armaganijan, L., et al. (2011) [preoperative use]

N-3 polyunsaturated fatty acid use was not associated with a reduction in postoperative atrial fibrillation. Similar results were observed when the open-label study was excluded.

 

 

 

 

Benedetto, U., et al. (2013) [preoperative and/or postoperative use]

N-3 PUFA: [risk ratio 0.89; 95% confidence interval (CI) 0.55-1.44; P=0.63]

 

 

 

 

Costanzo, S., et al. (2013) [preoperative use]

N-3 PUFA: (odds ratio, 0.75; 95% CI, 0.57-1.00; P =.05).

 

 

 

 

Guo, X. Y., et al. (2014)[ preoperative and postoperative use]

N-3 PUFA: odds ratio 0.76; 95% confidence interval [CI]: 0.57-1.03; P=0.08.

 

 

 

 

Langlois, P. L., et al. (2017) [preoperative and/or postoperative use]

N-3 PUFA: Odds Ratio = 0.78, 95% CI 0.68 to 0.90; P = 0.004

 

No effects on mortality

 

ICU LOS: difference in means: -2.95, 95% confidence interval, CI -10.28 to 4.39, P = 0.43).

hospital LOS: difference in means: -1.37, 95% CI -2.41 to -0.33; P = 0.010

Mariani, J., et al. (2013)[?]

N-3 PUFA: relative risk: 0.86; 95% CI, 0.71 to 1.04; a funnel plot suggested publication bias

 

 

 

 

Wang, H., et al. (2018) [preoperative use]

N-3 PUFA: relative risk: 0.68 [0.47-0.97], P = 0.03

 

 

 

 

Conclusion per outcome measure by Dutch guideline panel on perioperative nutritional support

Most systematic reviews on N-3 polyunsaturated fatty acid use show a moderate to small decrease in risk (<25% risk reduction).

No data

One systematic review shows N-3 polyunsaturated fatty acid use do not decrease mortality

No data

One systematic review shows a decreased ICU and hospital LOS, but ICU LOS decrease is very uncertain

 

Literatuur

Ali- Hasan- Al- Saegh, S., et al., (2016). "Impact of antioxidant supplementations on cardio-renal protection in cardiac surgery: an updated and comprehensive meta-analysis and systematic review." Cardiovascular therapeutics 34(5): 360-370.
Armaganijan, L., et al., (2011). "Do omega-3 fatty acids prevent atrial fibrillation after open heart surgery? A meta-analysis of randomized controlled trials." Clinics (Sao Paulo, Brazil). 66(11): 1923-1928.
Avenell, A., et al., (2016). "Nutritional supplementation for hip fracture aftercare in older people." Cochrane Database of Systematic Reviews 11: CD001880.
Baker, W. L. and C. I. Coleman (2016). "Meta-analysis of ascorbic acid for prevention of postoperative atrial fibrillation after cardiac surgery." American Journal of Health-System Pharmacy 73(24): 2056-2066.
Benedetto, U., et al., (2013). "n-3 Polyunsaturated fatty acids for the prevention of postoperative atrial fibrillation: a meta-analysis of randomized controlled trials." Journal of Cardiovascular Medicine 14(2): 104-109.
Costanzo, S., et al., (2013). "Prevention of postoperative atrial fibrillation in open heart surgery patients by preoperative supplementation of n-3 polyunsaturated fatty acids: an updated meta-analysis." Journal of Thoracic & Cardiovascular Surgery 146(4): 906-911.
Geng, J., et al., (2017). "The clinical benefits of perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery: a meta-analysis." Interactive Cardiovascular & Thoracic Surgery 25(6): 966-974.
Guo, X. Y., et al., (2014). "Omega-3 fatty acids for postoperative atrial fibrillation: alone or in combination with antioxidant vitamins?" Heart, Lung & Circulation 23(8): 743-750.
Hemila, H. and T. Suonsyrja (2017). "Vitamin C for preventing atrial fibrillation in high risk patients: a systematic review and meta-analysis." BMC Cardiovascular Disorders 17(1): 49.
Hill, A., et al., (2019). "Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis." Nutrients 11(9): 04
Langlois, P. L., et al., (2017). "Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An updated systematic review and meta-analysis." Clinical Nutrition 36(3): 737-746.
Mariani, J., et al., (2013). "N-3 polyunsaturated fatty acids to prevent atrial fibrillation: updated systematic review and meta-analysis of randomized controlled trials." Journal of the American Heart Association 2(1): e005033.
Putzu, A., et al., (2019). "The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review With Meta-Analysis of Randomized Controlled Trials." Critical Care Medicine 47(6): 774-783.
Shi, R., et al., (2018). "Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis of randomized controlled trials." Clinical Cardiology 41(6): 871-878.
Wang, H., et al., (2018). "N-3 polyunsaturated fatty acids for prevention of postoperative atrial fibrillation: updated meta-analysis and systematic review." Journal of Interventional Cardiac Electrophysiology 51(2): 105-115.