Impact of Perioperative Nutrition (± Immunonutrition) on Surgical Site Infection (SSI) Incidence ↓ and Wound Healing ↑ in Gastrointestinal (GI) Surgery Patients

Abstract

Background: Surgical site infection (SSI) remains a critical postoperative complication in gastrointestinal (GI) surgery, strongly influenced by perioperative nutritional status and the adjunctive role of immune nutrition. Objective: This study investigates the impact of perioperative nutrition, with and without immune nutrition, on reducing SSI incidence and enhancing wound healing among gastrointestinal surgery patients in a multicentral private hospital in Rajshahi. Methods: A prospective observational cohort of 68 GI surgery patients was enrolled from January–June 2023. Patients were stratified into two groups: perioperative standard nutrition (n=34) and perioperative immune nutrition (n=34). Nutritional risk screening, body mass index (BMI), serum albumin, C-reactive protein (CRP), wound healing index, and SSI incidence were assessed. Statistical analysis used independent t-tests, chi-square, and logistic regression with p<0.05 considered significant. Results: SSI incidence was significantly lower in the immune nutrition group (11.8%, n=4) compared with standard nutrition (29.4%, n=10; χ²=4.12, p=0.042). Mean wound healing index improved (7.8 ± 1.2 vs 6.1 ± 1.4; t=4.89, p<0.001). Serum albumin increased more markedly in the immune nutrition cohort (3.9 ± 0.5 g/dL vs 3.4 ± 0.6 g/dL; p=0.007). CRP decline was greater (−6.3 ± 1.1 mg/L vs −3.8 ± 1.4 mg/L; p<0.01). Logistic regression showed immune nutrition independently reduced SSI risk by 56% (OR 0.44, 95% CI: 0.21–0.92, p=0.031). Subgroup analysis revealed enhanced benefit in malnourished patients (albumin <3.5 g/dL) with a 65% reduction in infection rates. Conclusion: Perioperative immune nutrition significantly reduces SSI incidence and accelerates wound healing in gastrointestinal surgery patients, particularly in malnourished subgroups, underscoring its vital role in optimized surgical outcomes.