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Early Oral Feeding as Compared With Traditional Timing of Oral Feeding After Upper Gastrointestinal Surgery: A
Kate F Willcutts1, Mei C Chung, Cheryl L Erenberg
1*Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia and Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, NJ†Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA‡George F. Smith Library of the Health Sciences, Rutgers University, Newark, NJ§Department of Nutritional Sciences, Rutgers University, Newark, NJ¶Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia||Department of Nutritional Sciences, Graduate Programs in Clinical Nutrition, Rutgers University, School of Health Professions, Newark, NJ.
Insights
Early oral feeding after upper gastrointestinal surgery shortens hospital stays. This meta-analysis found no increase in complications, suggesting early feeding is safe and beneficial for recovery.
Area of Science:
- Gastroenterology and Surgical Outcomes
- Clinical Nutrition and Postoperative Care
Background:
- Early postoperative oral feeding is increasingly adopted in fast-track surgical protocols.
- Concerns persist regarding the safety of early oral intake following upper gastrointestinal surgery.
Purpose of the Study:
- To compare the clinical outcomes of early versus traditional (late) oral feeding after upper gastrointestinal surgery.
Main Methods:
- A systematic literature search was performed across 5 databases (1980-2015).
- Risk of bias was assessed, and random-effects meta-analyses were conducted for key outcomes.
- Included outcomes: anastomotic leaks, pneumonia, reinsertion of nasogastric tubes, reoperation, readmissions, and mortality.
Main Results:
- Fifteen studies with 2112 patients were analyzed.
- Early feeding significantly reduced mean hospital stay (WMD -1.72 days) and postoperative length of stay (WMD -1.44 days).
- No significant differences in anastomotic leaks, reinsertion of nasogastric tubes, reoperation, readmissions, or mortality were observed in RCTs; however, pooled analyses showed a reduced risk of pneumonia with early feeding (OR 0.6).
Conclusions:
- Early postoperative oral feeding is associated with a shorter hospital stay compared to traditional late feeding.
- Early feeding does not increase the risk of significant clinical complications after upper gastrointestinal surgery.
Objective:
To compare the effects of early oral feeding to traditional (or late) timing of oral feeding after upper gastrointestinal surgery on clinical outcomes.
Background:
Early postoperative oral feeding is becoming more common, particularly as part of multimodal or fast-track protocols. However, concerns remain about the safety of early oral feeding after upper gastrointestinal surgery.
Methods:
Comprehensive literature searches were conducted across 5 databases from January 1980 until June 2015 without language restriction. Risk of bias of included studies was appraised and random-effects model meta-analyses were performed to synthesize outcomes of anastomotic leaks, pneumonia, nasogastric tube reinsertion, reoperation, readmissions, and mortality.
Results:
Fifteen studies comprising 2112 adult patients met all the inclusion criteria. Mean hospital stay was significantly shorter in the early-fed group than in the late-fed group [weighted mean difference = -1.72 d, 95% confidence interval (CI) -1.25 to -2.20, P < 0.01). Postoperative length of stay was also significantly shorter (weighted mean difference = -1.44 d, 95% CI -0.68 to -2.20, P < 0.01). There was no significant difference in risk of anastomotic leak, pneumonia, nasogastric tube reinsertion, reoperation, readmission, or mortality in the randomized controlled trials (RCTs). The pooled RCT and non-RCT results, however, showed a significantly lower risk of pneumonia in early-fed as compared with late-fed group (odds ratio = 0.6, 95% CI 0.41-0.89, P = 0.01).
Conclusions:
Early postoperative oral feeding as compared with traditional (or late) timing is associated with shorter hospital length of stay and is not associated with an increase in clinically relevant complications.
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