{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:14:53Z","timestamp":1771481693031,"version":"3.50.1"},"reference-count":60,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hospital-acquired infections represent an increasingly urgent issue, particularly in intensive care and surgical settings, also in light of growing concerns about antibiotic resistance. Concurrently, nutrition\u2014due to its immunomodulatory effects\u2014is gaining attention as a key factor across multiple medical disciplines. The aim of this study was to assess perioperative nutritional interventions\u2014immunonutrition, probiotics, synbiotics, and protein integration\u2014in reducing surgical site infections (SSIs), healthcare-associated infections (HAIs) and hospital length of stay (LOS) in surgical patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive search on principal databases was performed on December 2024. As effect measures, was calculated the Odds Ratios (OR). The assessment of potential bias and the evaluation of study quality was conducted. Thirty-nine publications were selected for inclusion in the meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Immunonutrition was associated with a reduction in infectious complications (OR\u202f=\u202f0.36) and showed a probable reduction in SSIs (OR\u202f=\u202f0.35). Some benefits may also be obtained with the administration of probiotics (OR\u202f=\u202f0.61). Bloodstream infections (BSIs) appeared to be substantially reduced with probiotics (OR\u202f=\u202f0.42), although the certainty of evidence was low. Analytical studies showed weaker effects than RCTs of immunonutrition on SSI reduction compared with randomized control trials (RCTs), underscoring the importance of RCT evidence for clinical recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Based on RCT evidence, immunonutrition demonstrates robust efficacy in preventing SSIs with moderate certainty evidence, and appears ready for clinical implementation in high-risk surgical setting. Probiotics showed moderate effects on selected infectious outcomes, supported by low-certainty evidence, and may be considered as complementary interventions. Protein supplementation demonstrated statistical significance; however, the very low certainty of evidence precludes firm recommendations. Clinical implementation should prioritize interventions supported by RCT evidence within multimodal prevention strategies. Future research should address heterogeneity in nutritional formulations, standardize outcome definitions, and evaluate real-world effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1744249","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T05:24:09Z","timestamp":1771478649000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of nutritional supplementation in preventing postoperative complications: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Marina","family":"Sartini","sequence":"first","affiliation":[{"name":"Operating Unit Hospital Hygiene, Galliera Hospital","place":["Genoa, Italy"]},{"name":"Department of Health Sciences, University of Genoa","place":["Genoa, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Del Puente","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Galliera Hospital","place":["Genoa, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessio","family":"Carbone","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Genoa","place":["Genoa, Italy"]},{"name":"Division of Medical Oncology, Department of Medicine, Galliera Hospital","place":["Genoa, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martino","family":"Oliva","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Genoa","place":["Genoa, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Pessano","sequence":"additional","affiliation":[{"name":"Scientific Direction, Clinical Epidemiology Unit, IRCCS Giannina Gaslini","place":["Genoa, Italy"]},{"name":"Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Medical Statistics and Biometry Postgraduate School","place":["Pavia, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"Feasi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Galliera Hospital","place":["Genoa, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Piccinini","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Genoa","place":["Genoa, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Schinca","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Genoa","place":["Genoa, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"Ottria","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Genoa","place":["Genoa, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Luisa","family":"Cristina","sequence":"additional","affiliation":[{"name":"Operating Unit Hospital Hygiene, Galliera Hospital","place":["Genoa, Italy"]},{"name":"Department of Health Sciences, University of Genoa","place":["Genoa, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e1002150","DOI":"10.1371\/journal.pmed.1002150","article-title":"Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study","volume":"13","author":"Cassini","year":"2016","journal-title":"PLoS Med"},{"key":"ref2","volume-title":"National surveillance protocol for surgical site infections (SNICh2) and prevention indicators in hospitals","author":"Bandini","year":"2022"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"E273","DOI":"10.15167\/2421-4248\/jpmh2024.65.2.3141","article-title":"Surveillance of surgical site infections in orthopedic prosthetic surgery: a tool for identifying risk factors and improving clinical 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