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Normal Diet within Two Postoperative Days-Realistic or Too Ambitious?

Fabian Grass1, Markus Schäfer2, Nicolas Demartines3

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Nearly half of colorectal surgery patients experienced delayed normal diet tolerance, increasing complication risks. Prophylactic drains were the only modifiable factor linked to delayed oral intake, highlighting a target for improved recovery after surgery (ERAS) protocols.

Keywords:
colorectal surgerydietenhanced recoverynutritionrisk factors

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Area of Science:

  • Colorectal Surgery
  • Surgical Outcomes
  • Enhanced Recovery After Surgery (ERAS) Protocols

Background:

  • Enhanced Recovery After Surgery (ERAS) protocols recommend early postoperative diet resumption to mitigate surgical stress and catabolism.
  • Delayed tolerance of normal diet post-surgery can impede recovery and increase complication rates.

Purpose of the Study:

  • To identify risk factors associated with delayed tolerance of normal postoperative diet in colorectal surgery patients.
  • To compare surgical outcomes between patients with early versus delayed oral intake resumption.

Main Methods:

  • Retrospective analysis of 1301 consecutive colorectal surgical procedures from May 2011 to May 2017.
  • Uni- and multivariate logistic regression analysis to identify risk factors for delayed diet (beyond postoperative day 2).
  • Univariate analysis to compare surgical outcomes based on diet resumption timing.

Main Results:

  • 47% of patients experienced delayed normal diet tolerance (beyond postoperative day 2).
  • Independent risk factors for delayed tolerance included higher ASA score (≥3), abdominal drains, right colectomy, and Hartmann reversal.
  • Male gender was associated with earlier diet tolerance.
  • Delayed oral intake correlated with significantly higher rates of overall and major postoperative complications and longer hospital stays.
  • Prophylactic drain placement was the sole independent, modifiable risk factor for delayed oral intake.

Conclusions:

  • Over half of colorectal surgery patients in this cohort could not tolerate early enteral nutrition, indicating a significant challenge in ERAS protocol adherence.
  • Identifying and addressing modifiable risk factors, such as prophylactic drain use, is crucial for optimizing postoperative diet tolerance and patient outcomes.
  • Delayed oral intake is a significant predictor of adverse surgical outcomes, emphasizing the need for strategies to facilitate early enteral feeding.