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

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

22 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.",

year = "2022",

month = may,

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doi = "10.2106/JBJS.21.01014",

language = "English (US)",

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pages = "759--766",

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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 - Amino Acids, Essential

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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M3 - Article

C2 - 35286282

AN - SCOPUS:85129996549

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JO - Journal of Bone and Joint Surgery

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ER -

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

Abstract

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