Article 2 Discussion: Preoperative Immunonutrition in Surgery

The assignment discusses a discussion board post centered around the study by Barker et al., which evaluates the effect of preoperative immunonutrition on post-operative outcomes in well-nourished and malnourished patients undergoing major gastrointestinal surgery. The research highlights the challenges posed by adverse outcomes such as high treatment costs, increased mortality rates, impaired wound healing, and a depressed immune system following surgery due to malnutrition and stress. Immunonutrition is identified as having potential benefits for reducing early inflammation and improving recovery post-surgery; however, evidence regarding its efficacy based on nutritional status was previously lacking. The study employs a randomized controlled trial (RCT) method, randomly assigning patients to treatment or control groups in a 1:1 ratio while ensuring blinding among surgical staff, with researchers being the only ones aware of group allocations. This approach aims to minimize bias and strengthen the validity of the results. The paper underscores the importance of balanced group enrollment, randomization, allocation concealment, and strict adherence to trial protocols as essential for credible research outcomes in assessing immunonutrition's role in surgical recovery.

0Running head: ARTICLE 2 DISCUSSION
Article 2 discussion
Name of the student:
Name of the University:
Author’s note

1ARTICLE 2 DISCUSSION
Answer 1
The validity of the randomized controlled trial (RCT) by Barker et al. (2013) is
understood by its clear research purpose and focus. The review of the article showed that the
main purpose of the study was evaluating the effectiveness of preoperative immunonutrition
supplementation (intervention) on post operation outcomes (outcomes) between well
nourished (population studied) and malnourished gastrointestinal patients (comparator).
Hence, from this statement, the intervention provides and population studied is clearly
understood. The significance of this research is that it points out to the issue of adverse post
operative outcome in patient undergoing major gastrointestinal surgery due to malnutrition
and stress. Some of the adverse post operative outcome includes high treatment cost,
increased mortality, impaired wound healing, high infection rate and depressed immune
system. Depressed immunes system is one of the major challenges that contribute to other
negative issues in patient post surgery. Research has showed that immunonutrition has the
potential to minimize early inflammation in surgery and improve post operative outcomes
(Zheng et al. 2007). However, there is lack of evidence regarding the function of
immunoutrition according to nutritional status. Hence, the use of RCT to evaluate effect of
immunutrition supplementation on post operative outcome is an important research area that
will have many positive implications in the future.
Answer 2
One of the unique elements of RCT studies is that it studies the effect of any
intervention by randomization of patients to treatment and control group. Hence, apart from
the treatment, all other things and conditions must remain same in treatment and control
group. Barker et al. (2013) also treated the groups equally by maintaining a balanced group.
A balanced group can be assessed by the method of enrolment, randomization, allocation
concealment, blinding and follow up procedure used in the study (Farrokhyar et al. 2010). In

2ARTICLE 2 DISCUSSION
the study by Barker et al. (2013), participants were randomized into treatment or control
group in 1:1 ratio. Furthermore after admission, all surgical and hospital staffs were blinded
to patient’s treatment allocation and only researchers were blinded to participant’s treatment
group. This helps to minimize any potential bias during the research (Clark, Fairhurst and
Torgerson 2016). There was no lost to follow up case post the allocation too. In addition,
adherence to trial protocols also strengthens the validity and credibility of the group and
equal treatment of the group. Patients were also analyzed in the group to which they were
randomly assigned.

3ARTICLE 2 DISCUSSION
Reference
Barker, L.A., Gray, C., Wilson, L., Thomson, B.N.J., Shedda, S. and Crowe, T.C., 2013.
Preoperative immunonutrition and its effect on postoperative outcomes in well-nourished and
malnourished gastrointestinal surgery patients: a randomised controlled trial. European
journal of clinical nutrition, 67(8), pp.802-807.
Clark, L., Fairhurst, C. and Torgerson, D.J., 2016. Allocation concealment in randomised
controlled trials: are we getting better?. BMJ: British Medical Journal (Online), 355.
Farrokhyar, F., Bajammal, S., Kahnamoui, K. and Bhandari, M., 2010. Ensuring balanced
groups in surgical trials. Canadian Journal of Surgery, 53(6), p.418.
Zheng, Y.M., Li, F., Qi, B.J., Luo, B., Sun, H.C., Liu, S. and Wu, X.T., 2007. Application of
perioperative immunonutrition for gastrointestinal surgery: a meta-analysis of randomized
controlled trials. Asia Pacific journal of clinical nutrition, 16(S1), pp.253-257.