Seldom are differences between a control group and a treatment group in a randomized control study (RCT) as dramatic and clear as this.
A team from one of the top ranked U.S. academic medical centers, New York University’s (NYU) Langone Medical Center, designed an RCT study to measure the effects of nutrition on post-op outcomes, if any.
To begin with, a surprising number of spine surgery patients are under-nourished or even malnourished. “The prevalence of malnutrition in patients undergoing lumbar spine surgery ranges from 5% to 50% and is associated with higher rates of surgical site infections, medical complications, longer lengths of stay, and mortality,” the NYU team wrote in their paper.
The team (Hesham Saleh, M.D., Tyler K. Williamson, M.S. and Peter G. Passias, M.D.) designed a prospective randomized controlled trial to test the hypothesis that perioperative nutritional intervention could improve spine surgery and wound healing outcomes.
All patients enrolled in the study were 55 years of age or older and had registered preoperative albumin levels of < 3.5 g/dL. The intervention group received nutritional supplementation in the form of a protein shake twice a day after surgery starting immediately and continuing for two weeks post discharge. The control group did not get protein shakes and simply continued with their pre-existing daily diets.
The research team collected data on such minor in-hospital complications as wound drainage, electrolyte abnormalities, hypotension, ileus, deep venous thrombus, and wound healing complications within 90 days of surgery. They also measured 90-day emergency room visits, readmissions, and return to the operating room.
Thirty-seven of the 103 patients included in the study were considered malnourished before surgery. Forty-six of the patients received the nutritional intervention and 57 patients were in the control group.
Patients who received nutritional supplements had sharply lower rates of in-hospital complications (2.1% vs. 23.2%; p < 0.01) and perioperative wound healing complications (3.4% vs. 17.9%; p < 0.05).
A subgroup analysis of the 37 malnourished patients showed that those who received perioperative nutritional supplementation had dramatically lower rates of minor complications during admission (0.0% vs. 34.4%, p = 0.01) and return to the operating room within 90 days (0.0% vs. 12.4%; p = 0.04).
“To our knowledge, this is the first study to investigate the effects of perioperative nutritional intervention on wound healing complications for patients undergoing elective lumbar spine surgery,” the researchers wrote.
The study, “Perioperative Nutritional Supplementation Decreases Wound Healing Complications Following Elective Lumbar Spine Surgery: A Randomized Controlled Trial,” was published online on March 15, 2023 in the journal Spine.
I think this is a fantastic article and addition to the healthcare literature. It is part of our job to improve the health of our patients, and nutrition has always been an important factor in healing and proper growth.
I applaud the team who investigated this and has shared these important results.
I have been testing my patients nutritional status for years and have recommended a protein supplement for at least two weeks prior to surgery and a month following surgery to improve their recovery and hopefully put them on a path to better health for years to come after my joint replacement surgeries.
I find it also beneficial to recommend quality probiotics as we attack our patients microbiome with antibiotics during and after our surgeries and replenishing the gut bacteria is also critical for healthy recoveries.
Vitamin C is also a great cheap nutritional supplement that aids in collagen repair and reduces infection risk. There has been an abundance of literature showing the benefits of wound healing and infection management from Vitamin C and this can also be added to the surgeons repertoire of nutritional support for patients undergoing elective surgeries.