The clinical application of parenteral nutrition with Omega-3 fatty acids in patients after gastrectomy: a retrospective cohort study and cost-effectiveness analysis.

Abstract

Background: Postoperative complications of gastrectomy severely impact patient prognosis and impose a substantial economic burden. This study aims to assess the effect of adding omega-3 fish oil emulsion to parenteral nutrition on clinical outcomes and cost-effectiveness in gastric cancer populations after gastrectomy.

Methods: This retrospective cohort study included 150 gastric cancer patients after gastrectomy at Nanjing Drum Tower Hospital between September 2022 and September 2023. Patients were assigned to an omega-3 group and a control group based on whether they received postoperative omega-3 fish oil fat emulsion injection, with 53 matched pairs after propensity score matching (PSM). The primary outcome was the incidence of Grade II or higher complications. An economic evaluation was conducted from a hospital perspective, considering only direct medical costs over a 90-day horizon without discounting, using the incremental cost-effectiveness ratio (ICER). To evaluate the robustness of the primary findings, sensitivity analyses were performed using both one-way and probabilistic methods.

Results: After PSM, the omega-3 group demonstrated markedly lower incidences of both Grade II or higher complications (1/53 [1.9%] vs 9/53 [17.0%]; OR = 0.143, 95% CI: 0.015-0.656; P = 0.001) and intra-abdominal infection (0/53 [0%] vs 6/53 [11.3%]; OR = 0.073, 95% CI: 0.001-0.642; P = 0.014) than the control group. The white blood cell count on postoperative day 3 was significantly lower in the omega-3 group (P = 0.034). The cost-effectiveness analysis showed that the omega-3 group incurred an additional cost of 5,217.4 Chinese Yuan but achieved a 15.1% risk reduction in Grade II or higher complications, resulting in an ICER of 345.5. The probabilistic sensitivity analysis indicated a probability exceeding 98% that this strategy was more costly but more effective.

Conclusion: This retrospective single-center study observed an association between omega-3 fish oil emulsion and attenuated postoperative inflammation and complications. Although the intervention involved higher direct medical costs, these findings provide localized evidence for optimizing perioperative nutrition support.