NUTRIZIONE POSTOPERATORIA 'PROTEIN SPARING': STUDIO PROSPETTICO RANDOMIZZATO MULTICENTRICO SU 678 PAZIENTI

Objective: The metabolic effect of postoperative protein sparing therapy (PST) has been demonstrated by several studies, but the clinical utility of this treatment has not been investigated by large prospective trials. Design: A prospective multicenter randomized trial was designed to evaluate the clinical efficacy of postoperative PST. Patients and Methods: Six hundred and seventyeight patients undergoing major elective abdominal surgery were randomly assigned to receive either protein-sparing therapy after surgery (PST group) or conventional therapy (control group). The patients were monitored for major postoperative complications and mortality. Results: The rate of major postoperative complications were similar in both groups (PST group, 19.5 percent; control group 20.9 percent; p = 0.66), as were the overall postoperative mortality rates (4.7 percent and 3.5 percent, respectively; p = 0.43). There were no differences between PST and control group considering both major infectious and non infectious complications; the rates were 7.7 vs 5 percent (p = 0.15; relative risk 1.02; 95 percent confidence interval 0.98 to 1.07) and 15.1 vs 17.4 percent (p = 0.42; relative risk 0.97; 95 percent interval 0.91 to 1.04) respectively. Also when mildly malnurished patients (n. 147) were considered separately the rates of major postoperative complications resulted comparable in PST group and control patients: 29.9 vs 22.5 percent respectively (p = 0.31). Conclusions: The present study indicates that routine protein therapy for normonurished or mildly malnurished patients undergoing major abdominal surgery is not clinically justified.