Systematic nasogastric tube in aortic surgery: is it necessary?

Routine nasogastric tube (NGT) decompression has been traditionally used to prevent nausea and vomiting after abdominal surgery. Besides, many studies having demonstrated no benefits derived from this practice after an elective laparotomy, little evidence has been published regarding its use in aortic surgery. In this study, we analyze the effects of the selective use of the NGT in patients undergoing infrarenal aortic surgery in our center.

Prospective cohort study including patients who underwent elective infrarenal aortic surgery between January 2011 and December 2012. Patients were prospectively included in group A (systematic NGT placement) and group B (nonsystematic NGT). The main end point was the occurrence of postoperative nausea and vomiting (PONV). Secondary end points were postoperative complications, time to first oral intake, and hospital stay.

One hundred patients were finally included in the study, 50 patients per group. Preoperative and intraoperative data were similar between both groups. Higher incidence of PONV (48% vs. 10%; relative risk, 2.4; 95% confidence interval [CI], 1.3-4.5; P = 0.003) was observed in group A. Selective NGT behaved as a protective factor regarding earlier first oral intake in first postoperative 48 hours (hazard ratio, 0.67; 95% CI, 0.45-0.99; P = 0.05). There were no differences in other adverse events although a trend toward fewer respiratory complications was observed in patients with nonsystematic NGT.

This study demonstrates higher incidence of PONV and longer time to first oral intake in patients with systematic NGT with no benefits derived from this practice. Based on these results, selective NGT decompression should be encouraged in patients undergoing infrarenal aortic surgery.