Should Perioperative Immune-Modulating Nutrition Therapy Be the Standard of Care? A Systematic Review

Major surgery carries a significant risk of postoperative infections, such as surgical site infections. An estimated 500,000 surgical site infections occur annually at a cost of more the $1 billion/year in the US alone. Surgical trauma leads to an initial excessive inflammatory response, together with an almost immediate and dramatic depression of cell-mediated immunity. This immnosuppression may be due to a significant decrease in plasma arginine levels observed following surgery. This arginine deficiency can severely impair T-cell proliferation and key T-cell receptor function. Perioperative arginine administration can prevent arginine deficiency and restore cellular immunity. The purpose of this meta-analysis was to examine the relationship between immune-modulating enteral nutrition therapy (IMENT) containing arginine and infectious complications, length of stay, and mortality rates in surgical patients.