Clinical Studies

Scientific Evidence Guiding Advanced Patient Care

Clinical Studies

The Malnourished Surgery Patient: A Silent Epidemic in Perioperative Outcomes	View Study
Malnutrition is linked to worse postoperative outcomes, while perioperative supplementation with amino acids and micronutrients can improve recovery and reduce complications	View Study
Nutritional supplementation reduces wound complications in patients undergoing spinal fusion	View Study
Impact of nutritional status on surgical patients	View Study
Evaluating the Impact of Preoperative Nutritional Status on Surgical Outcomes and Public Health Implications in General Surgery Patients	View Study
Association of preoperative hypoprotein malnutrition with spinal postoperative complications and other conditions: A systematic review and meta-analysis	View Study
Preoperative Malnutrition Negatively Correlates With Postoperative Wound Complications and Infection After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis	View Study
The Effect of Quercetin on Inflammatory Factors and Clinical Symptoms in Women with Rheumatoid Arthritis: A Double-Blind, Randomized Controlled Trial	View Study
Perioperative Nutritional Optimization in Spine Surgery Gandhi S, Amakiri IC, Pittman J, White A. Global Spine Journal. 2022;12(8):1830–1836	View Study

1) Spine

Perioperative Nutritional Supplementation Decreases Wound Healing Complications Following Elective Lumbar Spine Surgery: A Randomized Controlled Trial.	PubMed
Effect of Protein Supplement on Paraspinal Muscles in Spine Fusion Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial.	PubMed/Free Full Text
Protein Supplement and Enhanced Recovery After Posterior Spine Fusion Surgery: A Randomized, Double-blind, Placebo-controlled Trial.	PubMed

2) Hip Fracture & Total Joint Surgery

Clinical Benefits of Oral Nutritional Supplementation for Elderly Hip Fracture Patients: A Single-Blind Randomised Controlled Trial.	PubMed/Journal
Perioperative Oral Nutritional Supplements in Normally or Mildly Undernourished Geriatric Patients Submitted to Surgery for Hip Fracture: A Randomized Clinical Trial.	PubMed
Essential Amino Acid Supplementation in Patients Following Total Knee Arthroplasty: Suppression of Quadriceps Muscle Atrophy and Accelerated Functional Recovery.	DOI

3) CaHMB / HMB – Muscle Preservation

Effect of Calcium β‑Hydroxy‑β‑Methylbutyrate (CaHMB), Vitamin D, and Protein Supplementation on Postoperative Immobilization in Malnourished Older Adult Patients with Hip Fracture: A Randomized Controlled Study.	PubMed
Effects of Supplementation with a Combination of β‑Hydroxy‑β‑Methylbutyrate, L‑Arginine, and L‑Glutamine on Postoperative Recovery of Quadriceps Muscle Strength After Total Knee Arthroplasty.	PubMed
HMB Supplementation in Surgical Patients: Meta‑analysis of Randomized Trials.	PubMed
In Healthy Older Adults, HMB Supplementation Preserves Muscle Mass During 10 Days of Bed Rest (Randomized Trial).	PubMed

4) Bromelain – Analgesic & Anti‑Inflammatory (Post‑operative)

Perioperative Bromelain Reduces Pain and Swelling and Improves Quality of Life After Mandibular Third Molar Surgery: A Randomized, Double‑Blind, Placebo‑Controlled Clinical Trial.	PubMed
Comparison of Efficacy and Safety of Bromelain with Diclofenac Sodium in the Management of Postoperative Pain and Swelling Following Mandibular Third Molar Surgery.	DOI
Effectiveness of Bromelain in the Control of Postoperative Pain After Periodontal Surgery: A Crossover Randomized Clinical Trial.	PubMed/Free Full Text
The Effectiveness of Bromelain on Oedema, Subconjunctival Haemorrhage, and Ecchymosis After Rhinoplasty: A Randomised, Double‑Blind, Placebo‑Controlled Trial.	PubMed

5) Arginine + Vitamin C + Zinc – Wound Healing

Treatment with Supplementary Arginine, Vitamin C and Zinc in Patients with Pressure Ulcers: A Randomised Controlled Trial.	PubMed
The Effect of Amino Acids on Wound Healing: A Systematic Review and Meta‑Analysis on Arginine and Glutamine.	PubMed/Free Full Text

6) Vitamin D & Bone Healing / Spine Outcomes

Vitamin D Levels and 1‑Year Fusion Outcomes in Elective Spine Surgery: A Prospective Observational Study.	PubMed
Vitamin D Supplementation Improves the Effects of the Rehabilitation Program on Balance and Pressure Distribution in Patients After Anterior Cervical Interbody Fusion (Randomized Controlled Trial).	PubMed/Free Full Text
Effect of Vitamin D3 Supplementation on Acute Fracture Healing: A Randomized Controlled Trial (Vita‑Shock).	PubMed/Free Full Text

Clinical Evidence on Supplements & Spine Surgery Patients

1. Protein Supplementation — Posterior Spine Fusion (PSF)

A 2021 RCT found that increased protein intake post-PSF:

Significantly improved vertebral fusion rates (P=0.019)
Reduced surgical-site infection and postoperative pain
Enhanced wound healing
Improved serum markers: high-sensitivity CRP ↓, IGF-1 ↑, albumin ↑, total protein ↑ The Source+8PubMed+8Nature+8

2. Vitamin D — Multiple Spine Contexts

a) Spinal Stenosis & PLIF Surgery

In deficient patients (<10 ng/mL), 3,200 IU/day vitamin D for 5 weeks pre-PLIF:
- Doubled serum 25(OH)D to sufficient levels
- Supported pain reduction and lowered inflammation markers (CRP, IL-6, TNF-α) Health+5Frontiers+5PubMed+5

b) Elective Lumbar Fusion

A 2022 RCT: 800 IU/day vitamin D + calcium for 3 months post-lumbar fusion:
- No significant long-term fusion rate difference at 1 year, but:
  - Time to fusion shortened (169 vs. 185 days, P=0.028)
  - Pain (VAS) and disability (ODI) scores improved at 6 months ScienceDirect+14BioMed Central+14National Spine Health Foundation+14

c) Observational Evidence

Vitamin D deficiency is common in spinal fusion patients and correlates with:
- Hardware failure (+26%) and delayed fusion IJSSurgery+7The Source+7ClinicalTrials.gov+7NASS Open Access

3. Combined Vitamin K₂ + D₃ — Osteoporotic Lumbar Fusion (2025)

45 mg K₂ + 250 IU D₃ + calcium for 6 months post-lumbar interbody fusion in osteoporotic patients:
- Complete fusion rates at 6 months: 91.7% vs. 74.3% (control); P=0.044
- Bone formation marker (P1NP) significantly higher at 3 months ClinicalTrials.gov+15Nature+15Examine+15

Additional Support & Rationale

Low pre-op vitamin D reliably predicts slower bone healing and hardware failure ScienceDirect IJSSurgery
Nutrition guidelines from National Spine Health & healthcare systems emphasize protein, vitamin C, zinc, vitamin K, vitamin D, and magnesium for optimal healing and inflammation control after spine surgery Brown Health+1National Spine Health Foundation+1

More Key Spine Surgery Nutrition Studies

1. Protein Supplementation Boosts Fusion & Recovery

A randomized, double-blind trial in posterior spine fusion (PSF) patients showed that supplementing with 36 g whey protein + 1.2 g/kg/day starting 48 hrs before surgery and continuing 1 month post-op resulted in:

Higher vertebral fusion rates (P = 0.019)
Reduced surgical-site infections and pain
Better serum markers: ↓ CRP and ↑ IGF-1, albumin, total protein, alkaline phosphatase ResearchGate+12Orthopedics This Week+12Journal of Neurological Surgery+12 ResearchGate+3PubMed+3ClinicalTrials.gov+3

2. Perioperative Nutrition Review Shows Better Outcomes

A 2018 review in Clinical Spine Surgery (Qureshi et al.) found that malnourished spine patients had:

More surgical complications
Higher infection rates
Longer hospital stays
It concluded that nutritional optimization — including protein-rich diets and immunonutrition — leads to better surgical outcomes PubMed+1Johns Hopkins University+1 MDPI+7PubMed+7Nature+7

3. NYU RCT: Protein Shakes Slash Complications

In elective lumbar spine surgery, patients with low pre-op albumin (<3.5 g/dL) received 2 protein shakes/day post-op. The intervention group had dramatically lower complications:
- In-hospital issues: 2.1% vs. 23.2%
Wound healing problems: 3.4% vs. 17.9% Lippincott Journals+12Orthopedics This Week+12Nature+12

4. Malnutrition = More Complications in Spine Metastases

A large MDPI study in patients with spinal metastases found that malnutrition was linked to:
- ↑ 30-day post-op complications (27.6% vs. 19.8%)
- Longer hospital stays
- More non-routine discharges & readmissions Lippincott Journals+3MDPI+3Journal of Neurological Surgery+3

5. Perioperative Nutrition Cuts Wound Complications

A systematic review (Clin Neurol Neurosurg, 2025) concluded that nutritional supplementation significantly reduces overall and wound-related complication rates. Nature+10ScienceDirect+10ScienceDirect+10

6. Nutritional Indices Predict Outcomes

Japanese study on the CONUT score found that pre-op under-nutrition is associated with increased risk of:

Major complications
Longer hospitalizations
Impaired wound healing after elective lumbar procedures Lippincott Journals+4Nature+4ScienceDirect+4

How Nutrition Transforms Surgical Recovery

1. Protein Supplementation Improves Muscle & Outcomes

A randomized trial in posterior spine fusion patients found that 36 g/day protein:
- Increased paraspinal muscle cross-sectional area
- Reduced muscle atrophy, pain, and disability post-surgery MDPI+15PMC+15Orthopedics This Week+15

2. Perioperative Protein Shakes Reduce Complicationsry

In patients with low pre-op albumin (< 3.5 g/dL), a twice-daily protein shake for 2 weeks post-discharge led to:
- Major reduction in in-hospital minor complications (2.1% vs. 23.2%)
- Fewer wound healing issues (3.4% vs. 17.9%) PubMed+1Orthopedics This Week+1

3. Immunonutrition Reduces Post-Op Complications

A study using arginine, glutamine, omega-3s, nucleotides (pre-op 6 days & post-op 6 days):
- 0 complications, re-ops, or readmissions in immunonutrition group vs. 10 events in control ResearchGate+7Austin Publishing Group+7CenterWatch+7

4. Systematic Reviews Highlight Nutrition’s Role

A 2025 meta-analysis in Clinical Neurology & Neurosurgery found perioperative nutrition significantly decreased overall and wound-specific complications in spine surgery ResearchGate+5PubMed+5MDPI+5

5. Malnutrition Linked to Worse Radiographic & Clinical Results

Japanese study in cervical laminoplasty patients showed:
- - Malnourished patients had greater post-op kyphosis
  - Poorer alignment (C2‑7 angle decrease) at 2 years PMC+15ResearchGate+15ClinicalTrials.gov+15

6. High Prevalence of Malnutrition in Spine Patients

Up to 25% of lumbar spine surgery patients are malnourished prior to surgery — malnutrition predicts higher complication risks ResearchGate+3journals.sagepub.com+3Orthopedics This Week+3

7. Enhanced Recovery Pathways Support Nutrition

ERAS (Enhanced Recovery After Surgery) studies emphasize early nutrition — carbohydrate & protein — to reduce stay length and complications after spine and hip procedures MDPI+1Austin Publishing Group+1

Clinical Studies

Scientific Evidence Guiding Advanced Patient Care