Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis.

Malnutrition is an independent risk factor for complications, mortality, wound healing, length of hospital stay, and costs. Associations between nutritional support and surgical patients remain controversial. Databases, including Pubmed, EMBASE, Web of Science, CNKI, VIP, and the Cochrane Library, were searched to find randomized controlled trials (RCTs) that assessed the effect of nutritional support on clinical outcomes in perioperative malnourished patients. The methodological quality of each included trial was assessed. A meta-analysis was conducted with Rev Man 5.2. Fifteen RCTs, involving 3831 patients, were included in this meta-analysis. Compared with control group, results showed that nutritional support was more effective in decreasing the incidence of infectious [relative risk (RR): 0.58; 95% CI: 0.50, 0.68; p<0.01] and non-infectious complications (RR: 0.74; 95% CI: 0.63, 0.88; p<0.01), and shortening the length of hospital stay [weighted mean difference (WMD): -2.64; 95% CI: -5.13, -0.16; p<0.05]. Moreover, the incidence of infectious complications in the immune nutrition group was significantly lower than that in the standard nutrition group (RR: 0.75; 95% CI: 0.58, 0.97; p<0.05). However, changes in hospital costs (WMD: 894; 95% CI: -1140, 2928; p>0.05) and postoperative mortality (RR: 0.77; 95% CI: 0.41, 1.44; p>0.05) between the nutritional support group and control group were not significantly different. In conclusion, perioperative nutritional support was superior in improving clinical outcomes in malnourished patients, which could significantly reduce the incidence of complications and effectively shorten the length of hospital stay. 营养不良是增加术后并发症发生率及病死率，延缓创伤愈合，延长住院时间 和增加住院费用的独立危险因素。营养支持适用于所有手术患者这一观点仍 存在争议。本Meta 分析检索6 个生物医学数据库（ 包括Pubmed 、 EMBASE、Web of Science、CNKI、VIP、The Cochrane Library) 的文献资 料。对纳入的随机对照研究进行方法学质量评定。应用Rev Man 5.2 软件进行 Meta 分析。本Meta 分析共纳入15 项符合标准的随机对照研究（n=3831）。 分析结果显示，与对照组比较，营养支持可明显降低患者术后感染性并发症 发生率（RR：0.58；95% CI：0.50，0.68; p<0.01），降低术后非感染性并发 症发生率（ RR ： 0.74 ； 95% CI ： 0.63 ， 0.88 ； p<0.01 ） ， 缩短住院时间 （WMD：-2.64；95% CI：-5.13，-0.16；p<0.05）。此外，实施免疫营养支持 较常规营养支持可以更有效地降低感染并发症发生率（RR：0.75；95% CI： 0.58，0.97；p<0.05）。但营养支持组与对照组患者之间住院费用（WMD： 894；95% CI：-1140，2928；p>0.05）和病死率（RR：0.77；95% CI：0.41, 1.44；p>0.05）无显著性差异。综上，围手术期营养支持对改善营养不良患者 临床结局具有优越性，可显著降低其并发症的发生率，缩短住院时间。.