***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial . AIMS OF THE PROJECT : To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and /or lead to improved clinical outcomes ( mortality rates , discharge destination , activities of daily living or length of hospital stay ) in non-malnourished community-dwelling older women with hip fracture . METHODS One hundred and nine women with BMI range 20 - 30 kg/m(2 ) were allocated to either nutritional supplements ( 352 kcal/day ) or usual hospital nutrition using a quasi-r and omisation technique . Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months . RESULTS No significant differences in weight change or clinical outcomes were seen between the two groups . Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change ( r=-0.36 , P=0.019 ) . CONCLUSIONS Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture . Whilst this may explain the lack of clinical improvements seen , our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients OBJECTIVE To improve the precision and reliability of estimates of the association between preoperative serum albumin concentration and surgical outcomes . DESIGN Prospect i ve observational study . Patients were followed up for 30 days postoperatively . Multiple logistic regression models were developed to evaluate serum albumin level as a predictor of operative mortality and morbidity in relation to 61 other preoperative patient risk variables . SETTING Forty-four tertiary care Veterans Affairs ( VA ) medical centers . PATIENTS A total of 54215 major noncardiac surgery cases from the National VA Surgical Risk Study . MAIN OUTCOME MEASURES Thirty-day operative mortality and morbidity . RESULTS A decrease in serum albumin from concentrations greater than 46 g/L to less than 21 g/L was associated with an exponential increase in mortality rates from less than 1 % to 29 % and in morbidity rates from 10 % to 65 % . In the regression models , albumin level was the strongest predictor of mortality and morbidity for surgery as a whole and within several subspecialties selected for further analysis . Albumin level was a better predictor of some types of morbidity , particularly sepsis and major infections , than other types . CONCLUSIONS Serum albumin concentration is a better predictor of surgical outcomes than many other preoperative patient characteristics . It is a relatively low-cost test that should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes , particularly in population s in whom comorbid conditions are relatively frequent OBJECTIVE Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications . The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients , using a higher dose of arginine ( 20 g per day ) could improve nutritional variables . MATERIAL S AND METHODS A population of 72 patients with oral and laryngeal cancer was enrolled . At surgery patients were r and omly allocated to two groups : a ) patients were receiving an enteral diet supplements with arginine and fiber ( group I ) ; b ) patients were receiving an isocaloric , isonitrogenous enteral formula ( group II ) . RESULTS No significant intergroup differences in the trend of the three serum proteins and lymphocytes were detected . Gastrointestinal tolerance ( diarrhea ) of both formulas was good ( 7.89 % group I and 5.88 % group II : ns ) . The postoperative infections complications were similar in both groups ( 23.6 % group I and 20.6 % group II : ns ) . Fistula was less frequent in enriched nutrition group ( 5.2 % group I and 17.6 % group II : p = 0.026 ) . The length of postoperative stay was better 24.3 + /- 14 days in the immunonutrition group than 36.1 + /- 27 days in the control group ( p = 0.036 ) . CONCLUSIONS Enriched formula improves local wound complications in postoperative head and neck cancer patients and decreases length of stay BACKGROUND & AIM The immunomodulating nutrition was supposed to reduce the incidence of complications in surgical patients , but many authors have question ed its value recently . The aim of the study was to assess the impact of enteral immunonutrition in postoperative period . METHODS Between January 2003 and December 2009 , 305 malnourished patients ( 123 F , 182 M , m. age 60.8 ) undergoing resection for pancreatic or gastric cancer , after preoperative 14 days of parenteral feeding , were r and omized in double-blind manner to receive either postoperative immunomodulating enteral diet ( IMEN ) or st and ard oligopeptide diet ( SEN ) . Outcome measures of the intend-to-treat analysis were : number and type of complications , length of hospitalization , mortality , and vital organ function . RESULTS Median postoperative hospital stay was 17.1 days in SEN and 13.1 days in IMEN group ( p = 0.006 ) . Infectious complications were observed in 60 patients ( 39.2 % ) in SEN and 43 ( 28.3 % ) in IMEN group ( p = 0.04 ) . Differences were also observed in overall morbidity ( 47.1 vs 33.5 % , p = 0.01 ) and mortality ( 5.9 vs 1.3 % , p = 0.03 ) , but the ratio of surgical complications , organ function , and treatment tolerance did not differ . CONCLUSIONS The study proved that postoperative immunomodulating enteral nutrition should be the treatment of choice in malnourished surgical cancer patients . The Clinical Trials Data base registry number : NCT00576940 BACKGROUND & AIMS Head and neck cancer surgery is affected by complications in 20 - 60 % of cases , with risk factors being malnutrition , alcoholism and immunosuppression due to cancer . The aim of the study was to investigate whether preoperative or perioperative immunonutrition could reduce postoperative infectious complications ( IC ) and surgical-site infections ( SSI ) in this population . METHODS This was a multicenter , prospect i ve , r and omized , double-blind study . Patients with oropharyngeal and pharyngolaryngeal tumour were r and omly allocated to three groups : a ) perioperative formula of Impact ( ® ) without immune nutrients , named " reference diet " ( group A , control ) ; b ) preoperative Impact ( ® ) and " reference diet " postoperatively ( group B ) ; c ) Impact ( ® ) perioperatively ( group C ) . Products were available in oral and enteral formula and were given 7 days before surgery and for 7 - 15 days postoperatively . The primary and secondary endpoints were the incidence of IC and SSI , respectively . RESULTS Of 312 r and omized patients , 205 were evaluable for ITT analysis . There was no significant difference in IC and SSI . However out of this population , only 64 patients had taken at least 75 % of the theoretical intake from surgery to day 10 ( per- protocol population ) . In this condition , a significant difference in IC ( OR = 0.24 , p = 0.05 ) , SSI ( OR = 0.17 , p = 0.04 ) and also in the median length of postoperative stay ( 18 vs. 25 days , p = 0.05 ) was demonstrated between groups A and C. CONCLUSIONS In the ITT population , no significant difference in IC , SSI and LOS was demonstrated . Positive exploratory results on the perioperative Impact ( ® ) per- protocol population , encourage further study in head and neck cancer patients . Registered under Clinical Trials.gov Identifier no. NCT00765440 Purpose To assess the potential relationship between preoperative nutritional status , including anthropometric parameters , and infection following total knee replacement surgery . Methods A total of 213 patients undergoing total knee replacement between December 2007 and May 2008 were prospect ively studied . Patients with rheumatoid arthritis were excluded . For each patient we pre-operatively checked biochemical and anthropometric parameters of nutrition information about co-morbidities such as diabetes and high blood pressure , ASA score , age , and gender . Information about early infections , both superficial and deep , was collected . A descriptive statistical analysis and univariate/multivariate logistic regression model for risk factors were performed . Results Eleven patients ( 5.16 % ) had an infection , 5 deep and 6 superficial . Neither co-morbidities nor preoperatively biochemical parameters were associated with infection . However , in the univariate logistic regression model there was an inversely proportional relationship between triceps skinfold ( TSF ) and infection . After adjusting for age , ASA score and gender ( multivariate logistic regression ) , TSF remained significantly associated with infection . Conclusion There was a statistically significant association between TSF and post-operative infection risk after TKR . Level of evidence Level I ( Prospect i ve prognostic study ) BACKGROUND Elderly patients and those with poor ventricular function have increased morbidity and mortality rates when undergoing surgery . We aim ed to ascertain whether an oral immune-enhancing nutritional supplement could improve preoperative host defence , and subsequently lower postoperative infections and organ dysfunction in patients undergoing elective cardiac surgery who are at high risk of infection . METHODS In this prospect i ve , r and omised , double-blind , placebo-controlled study , we r and omly assigned 50 patients who were scheduled to undergo coronary artery bypass to receive either an oral immune-enhancing nutritional supplement containing L-arginine , omega3 polyunsaturated fatty acids , and yeast RNA ( n=25 ) , or a control ( n=25 ) for a minimum of 5 days . Patients were included if they were aged 70 years or older , or had an ejection fraction of less than 0.4 , or were scheduled to undergo mitral valve replacement . The main outcome was preoperative host defence ( delayed-type hypersensitivity response to recall antigens , expression of HLA-DR epitopes on monocytes , and concentration of interleukin 6 in plasma ) . Analysis was per protocol . FINDINGS Five patients ( two in the treatment group ) were excluded because they did not take the minimum dose . Preoperative expression of HLA-DR epitopes on monocytes was significantly higher in patients given the study treatment ( 109 % [ 95 % CI 92 - 128 ] ) than those given the control ( 69 % [ 58 - 82 ] ) compared with baseline ( 100 % ) ( p=0.02 , repeated measures ANOVA ) . However , concentration of interleukin 6 was significantly lower in the treatment group ( 0.90 pg/L [ 0.69 - 1.18 ] ) than in the control group ( 1.94 pg/L [ 1.45 - 2.59 ] ) ( p=0.032 , repeated measures ANOVA ) . Additionally , delayed-type hypersensitivity response to recall antigens improved preoperatively and remained better until hospital discharge . INTERPRETATION Intake of an oral immune-enhancing nutritional supplement for a minimum of 5 days before surgery can improve outlook in high-risk patients who are undergoing elective cardiac surgery OBJECTIVES /HYPOTHESIS Malnutrition is a significant risk factor for postoperative infections in patients undergoing oncologic surgery . This study was undertaken to determine if perioperative nutritional supplementation with an immune-enhancing formula is superior to st and ard formula in the prevention of postoperative infectious complications . STUDY DESIGN This was a prospect i ve , r and omized , double-blind trial comparing perioperative nutritional supplementation with Impact and st and ard nutritional formulas . METHODS Following stratification , 136 patients undergoing oncologic head and neck surgery were r and omly assigned to one of four treatment groups : preoperative/postoperative Impact , postoperative Impact , preoperative/postoperative st and ard formula , and postoperative st and ard formula . Outcome measures included laboratory evaluations of nutritional status , infectious and wound healing complications , and duration of hospitalization . Statistical analysis was performed using chi2 or two-tailed Fisher Exact Tests , when appropriate . RESULTS Intent-to-treat ( P = .02 ) and actual therapy ( P = .04 ) analyses revealed a significant decrease in the incidence of postoperative infectious complications ( all sites ) in patients who received Impact . There was no significant difference in wound healing problems or duration of hospitalization . Postoperative measures of nutrition status demonstrated a higher serum albumin ( P = .05 ) in patients who received Impact compared with st and ard formula . CONCLUSIONS Compared with st and ard formula , perioperative nutritional supplementation with Impact significantly reduced the incidence of infectious complications . The length of hospitalization was significantly prolonged in patients with postoperative 
    Output:
    
Findings from this planned review may inform subsequent nutritional interventions for hospitalised patients who undergo surgery .