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Surgical Support – Postoperative Care

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Surgical Support – Postoperative Care

Postoperative Support

Physiological responses to surgical procedures impact various outcomes such as length of hospital stays and postoperative complications.1,2,3 Targeting mechanisms that help regulate inflammation and immune function is key to an integrative treatment plan.

Regulation of post-surgical immune function and inflammation may be achieved through decreasing pro-inflammatory cytokines, such as tumor necrosis factor (TNFα) and interleukins.4,5,6 It is hypothesized that gene expressions of TNF and interleukin-6 (IL-6) are correlated with the gene expression of suppressor of cytokine stimulation-3 (SOCS3), providing insight into the possible mechanism through which decreased inflammation is achieved.1

Decreasing oxidative stress may also improve inflammatory response. Focusing on maintaining adequate plasma and RBC glutathione levels, as well as a favorable glutathione to glutathione disulfide ratio, assists in the attenuated loss of anti-oxidants.7 Additionally, interventions aimed at improving neutrophil phagocytosis show potential in upregulating immune function post-operatively.8

The ingredients presented in the protocol below reflect research findings that demonstrate the efficacy of dietary supplements when used to support physiological function following surgical interventions.

Probiotics

Specific probiotics strains may reduce the incidence of common postoperative complications such as infection. However, outcomes are dependent on type of surgery, demographic, strain, and dosing. Listed below are three possible strain combinations with associated outcomes.9,5,10,11

Strain combination 1

  • Dosing: 30 billion CFU of Bifidobacterium bifidum, Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus acidophilus, Lactobacillus casei subsp, Lactobacillus lactis, twice per month, 6 months beginning 4 weeks post-surgery
  • Scenario: postoperative complications in colorectal cancer5
    • Reduced inflammation, demonstrated by decreased serum levels of TNFα and interleukins IL-6, IL-10, IL-12, IL-17A, IL-17C, and IL-22 when compared to placebo
Probiotic strain combination 1 in the Fullscript catalog

Strain combination 2

  • Dosing: 5.5 billion CFU probiotic containing Lactobacillus acidophilus, Lactobacillus plantarum, Bifidobacterium lactis, and Saccharomyces boulardii, once per day, 14 days starting on the day of surgery
  • Scenario: postoperative complications in colorectal cancer1
    • Decreased rate of colorectal surgery complications by 20.2%, including the rate of postoperative pneumonia by 8.9%, surgical site infection by 12.9%, and anastomotic leakage by 7.6% when compared to placebo
      Length of hospital stay shortened by two days in patients receiving probiotics
Probiotic strain combination 2 in the Fullscript catalog

Strain combination 3

  • Dosing: 4 billion CFU probiotic containing Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus casei, Bifidobacterium bifidum and 100 mg of fructooligosaccharides, twice a day, 14 days perioperatively
  • Scenario: postoperative complications in periampullary neoplasm2
    • Reduced the rate of postoperative infection incidence by 43.5% when compared to placebo
    • Decreased mean length of hospital stay from 23 days to 12 days
    • Reduced postoperative mortality; no occurrences of death were experienced in the probiotic group when compared to 6 deaths recorded in the placebo group
Probiotic strain combination 3 in the Fullscript catalog

Magnesium

800 mg magnesium oxide (240 mg elemental magnesium), once per day, from admission to discharge of hospital or 2 g or 5-50 mg/kg of intravenous magnesium in the form of levulinate, gluconate, sulfate, or chloride, on day of surgery3,12,13,14

  • Oral magnesium oxide reduced gastrointestinal incidences of nausea, vomiting, and constipation in postoperative coronary artery bypass graft surgery when compared to control3
  • Incidences of hypomagnesemia, associated with high occurrences in cardiac surgery, decreased by 29.3% in oral magnesium oxide supplementation, demonstrating an overall decrease in postoperative complications such as morbidity3
  • Decreased incidence of postoperative arrhythmias when compared to controls in pediatric patients14
  • Postoperative ventricular dysrhythmias decreased, as well as ventilatory support for postoperative cardiac patients treated with intravenous magnesium chloride12
  • Preventing postoperative hypomagnesemia via perioperative magnesium supplementation decreased the number of incidences of postoperative shivering13
Magnesium in the Fullscript catalog

Glutamine

0.18-0.4 g/kg, once per day, 1-7 days subsequent to surgery8,15,16

  • Maintained muscular protein synthesis, as measured by muscular ribosomal concentration, which is typically reduced following surgical trauma17
  • Increased T-cell DNA synthesis, indicating enhancement of T-cell function in postoperative colorectal resection16
  • Decreased length of hospital stays by 2.5 to 4 days when compared to controls7,15
  • Attenuated loss of anti-oxidants, demonstrated by a maintenance of plasma and RBC glutathione levels and glutathione to glutathione disulfide ratio7
  • Neutrophil phagocytosis increased, demonstrating increased immune function8
Glutamine in the Fullscript catalog

Omega-3 fatty acids

0.1-0.2 g/kg once per day of omega-3 fatty acids, seven days subsequent to surgery4,8

Disclaimer: Changes in blood flow or coagulation related to altered levels of fibrinogen, factor V, and triglycerides may occur in select populations17,18,19

  • Neutrophil phagocytosis increased for postoperative colorectal cancer patients whose standard total parenteral nutrition was supplemented with omega-3 fatty acids8
  • Length of hospital stay decreased in postoperative colorectal cancer patients who had a radical resection4
  • Improved postoperative immune function and inflammation as indicated by lower levels of IL-6, TNFα, and C-reactive protein4,20
Omega-3 fatty acids in the Fullscript catalog

Branched-chain amino acids

4.74 – 5.56 g branched-chain amino acids (BCAAs), 2-3 times per day, starting two weeks prior to surgery, and continued for three to six months subsequent to surgery21,22

  • Compared to a control group, individuals receiving BCAA supplementation demonstrated anti-catabolic effects leading to improved metabolic status, which was indicated by improved BCAA-to-tyrosine ratio, nitrogen equilibrium, and favorable levels of retinol binding protein23,24
  • Decreased mean length of hospital stays from 19 days to 17 days and overall incidence of postoperative complications by 26.9% when compared to placebo22,25
  • Events of hepatic recurrence were decreased postoperatively, which subsequently relieved mental stress22,21
Branched-chain amino acids in the Fullscript catalog

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

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References

11
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/29202875/
13
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/17513654/
14
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/23443885/
20
Systematic review or meta-analysis of human trials
a
https://pubmed.ncbi.nlm.nih.gov/29668624/
24
RDBPC human trials
c
https://pubmed.ncbi.nlm.nih.gov/464673/

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