Search

Immuno-nutrition administers specific nutrients to improve host defences, in particular supporting the immune system. Given the high invasiveness of some spine operations, strengthening the immune response could effectively balance the surgical stress and boost resilience. However, it is not clear what are the early molecular signatures after the consumption of immuno-modulatory nutrients. In the context of nutritional prehabilitation, we present the case of a lady with scoliosis scheduled for surgery who was administered immuno-nutrition preoperatively and tested for acute changes in 200 biomolecules after two and four hours. After four hours, we mainly observed 30-fold increase in IL-10, 10-fold increase in IL-18 inhibitory protein, 6-fold increase in IL-1 inhibitory receptor, 12-fold decrease in IL-2 receptor, and 51-fold decrease in IL-23. Gene ontology annotations showed the involvement of genes regulating cytokine activity, response to external organisms, humoral and adaptive response, and lymphocyte immunity. Overall, the trends over the first four hours showed a positive shift of the cytokine balance in favour of anti-inflammatory mediators while keeping active the cell-mediated immunity. The use of immuno-nutrition for prehabilitation patients could prove useful to patients but benefits from chronic consumption and surgical outcomes remain to be determined. [ABSTRACT FROM AUTHOR]

In the past, good food and exercise were not considered effective interventions to promote recovery in orthopedic surgery, and prolonged bed rest with not many calories has been deemed sufficient for the proper health restoration until the end of the nineteenth century. The advancement of scientific knowledge proved just the opposite, thus pushing health professionals to sustain the nutritional status and physical fitness of surgical patients. Nevertheless, the impoverishment of lifestyles and the lengthening of life expectancy have invariably contrasted the strength of constitution, giving rise to two of the most hazardous conditions for orthopedic patients: malnutrition and sarcopenia, often hiding nutrient deficits and poor body composition. These conditions are known to be negative prognostic factors in several areas of major surgery, including hip replacement, knee replacement, and spine surgery. Scoring systems to screen for malnutrition and physical inabilities exist, but disciplined management of the derived risks remains untested, potentially hindering the implementation of research findings into practice. A methodical approach of preoperative analysis, critical monitoring, and risk correction before surgery could lead to a substantial improvement of the prognosis while warranting the safety of patients and the efficiency of enhanced recovery after surgery pathways. The aim of this article is to discuss from a dietetic and exercise perspective the ideal nutritional and physical prehabilitation to lay the foundations for designing the appropriate integration of dietitians and physiotherapists in a preoperative enhanced recovery pathway. This methodical analysis could effectively calculate the patient's risks, detect the best choices for resolving the risk, underline the ignored aspects of perioperative care, and represent a concrete means to integrate novel discoveries. [ABSTRACT FROM AUTHOR]

Over the last 15 years, orthopedic departments have begun to consider a multidisciplinary approach in the management of hip/knee arthroplasty and spine surgery. However, much misperception persists on the founding concepts of rapid-recovery approaches, and most of the programs in orthopedics lacks nutritional support. Despite the complexities of nutritional parameters prognostic potentials, associated interventions mainly focused on using dietary supplements. Nevertheless, an effective integrative nutritional support program for enhancing recovery after surgery should comprehensively account for pre-operative nutritional counseling and optimization, shortening fasting time, early postoperative feeding and integration, and follow-up dietary management after discharge. [ABSTRACT FROM AUTHOR]