The review of 19 RCTs shows a reduction in length of stay (LOS) of 1.4 days and a 22% lower incidence of post-operative atrial fibrillation (POAF).
“This updated systematic review and meta-analysis, demonstrates that administered to patients undergoing cardiac surgery may be able to significantly reduce hospital LOS and the incidence of POAF,” conclude the authors led by Pascal Langlois of Sherbrooke University, Quebec.
However, the authors acknowledge that the shorter recovery time may be due to the reduction in POAF.
“Nevertheless, the wide range of doses, length of administration and type of surgery lead to significant heterogeneity, which should prompt the reader to be careful in results interpretation,” said Langlois and his team writing in Clinical Nutrition.
Langlois said the findings show promise for future use of perioperative long chain omega-3 therapy.
Aggregated results show no significant improvement in other clinical outcome measures such as intensive care unit LOS and mortality.
However, “We found a significant POAF reduction when ω-3 PUFA doses were administered to patients exposed to extra-corporeal circulation,” noted the team.
Anti-inflammatory effect
The updated review provides a new perspective on omega-3 benefits as most previous meta-analyses had focused purely on POAF rather than clinical outcomes, and had produced contradictory results.
“Our overall hypothesis was that omega-3 PUFA administration could have a positive impact on systemic inflammation and immune response and consequently be associated with reduced POAF, shorter length of stay and potentially, other improved clinical outcomes,” Langlois claimed.
The anti-inflammatory effect appears especially noticeable in extra-corporeal circulation patients.
“It seems logical that patients exposed to extra-corporeal circulation develop more intense systemic inflammatory response syndrome through contact of blood with non-endothelial surfaces and could benefit from anti-inflammatory/immunomodulatory treatment,” they suggest.
Oral/enteral and parenteral omega-3 administration show improvements in LOS and POAF. However, the former two methods produce greater POAF reduction.
Dosage of up to 2g/day seems to be best for reducing arrhythmia, with supplementation above this level showing no additional benefit.
The results may help justify “Large-scale and well-designed RCT, which should be aimed at confirming our observations,” the team added.
Source: Clinical Nutrition
Volume 36, Issue 3, Pages 737-746, doi.org/10.1016/j.clnu.2016.05.013
“Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An updated systematic review and meta-analysis”
Authors: Pascal L Langlois, Gil Hardy, William Manzanares