Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and Muscle Wasting After Fracture Fixation: A Randomized Controlled Trial

Nathan R. Hendrickson; John Davison; Natalie A. Glass; Erin S. Wilson; Aspen Miller; Steven Leary; William Lorentzen; Matthew D. Karam; Matthew Hogue; J. Lawrence Marsh; Michael C. Willey

doi:10.2106/JBJS.21.01014

Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and Muscle Wasting After Fracture Fixation: A Randomized Controlled Trial

Nathan R. Hendrickson, John Davison, Natalie A. Glass, Erin S. Wilson, Aspen Miller, Steven Leary, William Lorentzen, Matthew D. Karam, Matthew Hogue, J. Lawrence Marsh, Michael C. Willey

Orthopaedic Surgery

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

BACKGROUND: Postoperative complications and substantial loss of physical function are common after musculoskeletal trauma. We conducted a prospective randomized controlled trial to assess the impact of conditionally essential amino acid (CEAA) supplementation on complications and skeletal muscle mass in adults after operative fixation of acute fractures.

METHODS: Adults who sustained pelvic and extremity fractures that were indicated for operative fixation at a level-I trauma center were enrolled. The subjects were stratified based on injury characteristics (open fractures and/or polytrauma, fragility fractures, isolated injuries) and randomized to standard nutrition (control group) or oral CEAA supplementation twice daily for 2 weeks. Body composition (fat-free mass [FFM]) was measured at baseline and at 6 and 12 weeks postoperatively. Complications were prospectively collected. An intention-to-treat analysis was performed. The relative risk (RR) of complications for the control group relative to the CEAA group was determined, and linear mixed-effects models were used to model the relationship between CEAA supplementation and changes in FFM.

RESULTS: Four hundred subjects (control group: 200; CEAA group: 200) were enrolled. The CEAA group had significantly lower overall complications than the control group (30.5% vs. 43.8%; adjusted RR = 0.71; 95% confidence interval [CI] = 0.55 to 0.92; p = 0.008). The FFM decreased significantly at 6 weeks in the control subjects (-0.9 kg, p = 0.0205), whereas the FFM was maintained at 6 weeks in the CEAA subjects (-0.33 kg, p = 0.3606). This difference in FFM was not seen at subsequent time points.

CONCLUSIONS: Our results indicate that CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. Given the potential benefits of this inexpensive, low-risk intervention, multicenter prospective studies in focused trauma populations are warranted.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Original language	English (US)
Pages (from-to)	759-766
Number of pages	8
Journal	Journal of Bone and Joint Surgery
Volume	104
Issue number	9
DOIs	https://doi.org/10.2106/JBJS.21.01014
State	Published - May 4 2022

Bibliographical note

Funding Information:
This research was supported by a grant from the American Academy of Orthopaedic Surgeons Board of Specialty Societies Quality and Patient Safety Action Fund.

Publisher Copyright:
Copyright © 2022 By The Journal Of Bone And Joint Surgery, Incorporated.

Keywords

Adult
Amino Acids, Essential
Dietary Supplements
Fracture Fixation/methods
Fracture Fixation, Internal/methods
Fractures, Bone/surgery
Humans
Muscles
Postoperative Complications/prevention & control
Prospective Studies

PubMed: MeSH publication types

Research Support, Non-U.S. Gov't
Randomized Controlled Trial
Multicenter Study
Journal Article

Publisher link

10.2106/JBJS.21.01014

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Hendrickson, N. R., Davison, J., Glass, N. A., Wilson, E. S., Miller, A., Leary, S., Lorentzen, W., Karam, M. D., Hogue, M., Marsh, J. L., & Willey, M. C. (2022). Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and Muscle Wasting After Fracture Fixation: A Randomized Controlled Trial. Journal of Bone and Joint Surgery, 104(9), 759-766. https://doi.org/10.2106/JBJS.21.01014

Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and Muscle Wasting After Fracture Fixation: A Randomized Controlled Trial. / Hendrickson, Nathan R.; Davison, John; Glass, Natalie A. et al.
In: Journal of Bone and Joint Surgery, Vol. 104, No. 9, 04.05.2022, p. 759-766.

Research output: Contribution to journal › Article › peer-review

Hendrickson, NR, Davison, J, Glass, NA, Wilson, ES, Miller, A, Leary, S, Lorentzen, W, Karam, MD, Hogue, M, Marsh, JL & Willey, MC 2022, 'Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and Muscle Wasting After Fracture Fixation: A Randomized Controlled Trial', Journal of Bone and Joint Surgery, vol. 104, no. 9, pp. 759-766. https://doi.org/10.2106/JBJS.21.01014

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title = "Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and Muscle Wasting After Fracture Fixation: A Randomized Controlled Trial",

abstract = "BACKGROUND: Postoperative complications and substantial loss of physical function are common after musculoskeletal trauma. We conducted a prospective randomized controlled trial to assess the impact of conditionally essential amino acid (CEAA) supplementation on complications and skeletal muscle mass in adults after operative fixation of acute fractures.METHODS: Adults who sustained pelvic and extremity fractures that were indicated for operative fixation at a level-I trauma center were enrolled. The subjects were stratified based on injury characteristics (open fractures and/or polytrauma, fragility fractures, isolated injuries) and randomized to standard nutrition (control group) or oral CEAA supplementation twice daily for 2 weeks. Body composition (fat-free mass [FFM]) was measured at baseline and at 6 and 12 weeks postoperatively. Complications were prospectively collected. An intention-to-treat analysis was performed. The relative risk (RR) of complications for the control group relative to the CEAA group was determined, and linear mixed-effects models were used to model the relationship between CEAA supplementation and changes in FFM.RESULTS: Four hundred subjects (control group: 200; CEAA group: 200) were enrolled. The CEAA group had significantly lower overall complications than the control group (30.5% vs. 43.8%; adjusted RR = 0.71; 95% confidence interval [CI] = 0.55 to 0.92; p = 0.008). The FFM decreased significantly at 6 weeks in the control subjects (-0.9 kg, p = 0.0205), whereas the FFM was maintained at 6 weeks in the CEAA subjects (-0.33 kg, p = 0.3606). This difference in FFM was not seen at subsequent time points.CONCLUSIONS: Our results indicate that CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. Given the potential benefits of this inexpensive, low-risk intervention, multicenter prospective studies in focused trauma populations are warranted.LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.",

keywords = "Adult, Amino Acids, Essential, Dietary Supplements, Fracture Fixation/methods, Fracture Fixation, Internal/methods, Fractures, Bone/surgery, Humans, Muscles, Postoperative Complications/prevention & control, Prospective Studies",

author = "Hendrickson, {Nathan R.} and John Davison and Glass, {Natalie A.} and Wilson, {Erin S.} and Aspen Miller and Steven Leary and William Lorentzen and Karam, {Matthew D.} and Matthew Hogue and Marsh, {J. Lawrence} and Willey, {Michael C.}",

note = "Funding Information: This research was supported by a grant from the American Academy of Orthopaedic Surgeons Board of Specialty Societies Quality and Patient Safety Action Fund. Publisher Copyright: Copyright {\textcopyright} 2022 By The Journal Of Bone And Joint Surgery, Incorporated.",

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language = "English (US)",

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T1 - Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and Muscle Wasting After Fracture Fixation

T2 - A Randomized Controlled Trial

AU - Hendrickson, Nathan R.

AU - Davison, John

AU - Glass, Natalie A.

AU - Wilson, Erin S.

AU - Miller, Aspen

AU - Leary, Steven

AU - Lorentzen, William

AU - Karam, Matthew D.

AU - Hogue, Matthew

AU - Marsh, J. Lawrence

AU - Willey, Michael C.

N1 - Funding Information: This research was supported by a grant from the American Academy of Orthopaedic Surgeons Board of Specialty Societies Quality and Patient Safety Action Fund. Publisher Copyright: Copyright © 2022 By The Journal Of Bone And Joint Surgery, Incorporated.

PY - 2022/5/4

Y1 - 2022/5/4

N2 - BACKGROUND: Postoperative complications and substantial loss of physical function are common after musculoskeletal trauma. We conducted a prospective randomized controlled trial to assess the impact of conditionally essential amino acid (CEAA) supplementation on complications and skeletal muscle mass in adults after operative fixation of acute fractures.METHODS: Adults who sustained pelvic and extremity fractures that were indicated for operative fixation at a level-I trauma center were enrolled. The subjects were stratified based on injury characteristics (open fractures and/or polytrauma, fragility fractures, isolated injuries) and randomized to standard nutrition (control group) or oral CEAA supplementation twice daily for 2 weeks. Body composition (fat-free mass [FFM]) was measured at baseline and at 6 and 12 weeks postoperatively. Complications were prospectively collected. An intention-to-treat analysis was performed. The relative risk (RR) of complications for the control group relative to the CEAA group was determined, and linear mixed-effects models were used to model the relationship between CEAA supplementation and changes in FFM.RESULTS: Four hundred subjects (control group: 200; CEAA group: 200) were enrolled. The CEAA group had significantly lower overall complications than the control group (30.5% vs. 43.8%; adjusted RR = 0.71; 95% confidence interval [CI] = 0.55 to 0.92; p = 0.008). The FFM decreased significantly at 6 weeks in the control subjects (-0.9 kg, p = 0.0205), whereas the FFM was maintained at 6 weeks in the CEAA subjects (-0.33 kg, p = 0.3606). This difference in FFM was not seen at subsequent time points.CONCLUSIONS: Our results indicate that CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. Given the potential benefits of this inexpensive, low-risk intervention, multicenter prospective studies in focused trauma populations are warranted.LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

AB - BACKGROUND: Postoperative complications and substantial loss of physical function are common after musculoskeletal trauma. We conducted a prospective randomized controlled trial to assess the impact of conditionally essential amino acid (CEAA) supplementation on complications and skeletal muscle mass in adults after operative fixation of acute fractures.METHODS: Adults who sustained pelvic and extremity fractures that were indicated for operative fixation at a level-I trauma center were enrolled. The subjects were stratified based on injury characteristics (open fractures and/or polytrauma, fragility fractures, isolated injuries) and randomized to standard nutrition (control group) or oral CEAA supplementation twice daily for 2 weeks. Body composition (fat-free mass [FFM]) was measured at baseline and at 6 and 12 weeks postoperatively. Complications were prospectively collected. An intention-to-treat analysis was performed. The relative risk (RR) of complications for the control group relative to the CEAA group was determined, and linear mixed-effects models were used to model the relationship between CEAA supplementation and changes in FFM.RESULTS: Four hundred subjects (control group: 200; CEAA group: 200) were enrolled. The CEAA group had significantly lower overall complications than the control group (30.5% vs. 43.8%; adjusted RR = 0.71; 95% confidence interval [CI] = 0.55 to 0.92; p = 0.008). The FFM decreased significantly at 6 weeks in the control subjects (-0.9 kg, p = 0.0205), whereas the FFM was maintained at 6 weeks in the CEAA subjects (-0.33 kg, p = 0.3606). This difference in FFM was not seen at subsequent time points.CONCLUSIONS: Our results indicate that CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. Given the potential benefits of this inexpensive, low-risk intervention, multicenter prospective studies in focused trauma populations are warranted.LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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KW - Dietary Supplements

KW - Fracture Fixation/methods

KW - Fracture Fixation, Internal/methods

KW - Fractures, Bone/surgery

KW - Humans

KW - Muscles

KW - Postoperative Complications/prevention & control

KW - Prospective Studies

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Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and Muscle Wasting After Fracture Fixation: A Randomized Controlled Trial

Abstract

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