Benefits of early feeding versus traditional nil-by-mouth nutritional postoperative management in gastrointestinal resectional surgery patients: a meta-analysis

Abstract

The objective of the current work was to conduct a meta-analysis of randomized controlled trials evaluating the effect on surgical outcomes of providing nutrition within 24-hours following gastrointestinal surgery compared with traditional postoperative management. A literature search was conducted to identify randomized controlled trials published in English language between1966 and 2007 comparing the outcomes of early and traditional postoperative feeding. All trials involving resection of the portions of the gastrointestinal tract followed by patients receiving nutritionally significant oral or enteral intake within 24-hours after surgery were included for analysis. Random effects meta-analyses were performed. Outcome variables analyzed were complications, mortality, anastomotic dehiscence, nasogastric reinsertion, days to passing flatus, days to first bowel motion, and length of stay. Fifteen studies (n=1240 patients) were analyzed. A statistically significant forty-five percent reduction in relative odds of total postoperative complications were seen in patients receiving early postoperative feeding (OR 0.55 CI 0.35, 0.87, p=0.01). No effect of early feeding was seen with relation to anastomotic dehiscence (OR 0.75, CI 0.39, 1.4, p=0.39), mortality (OR 0.71, CI 0.32,1.56, p= 0.39), resumption of bowel function as evidenced by days to passage of flatus (WMD -0.42, CI -1.12, 0.28, p=0.23) and first bowel motion (WMD -0.28, CI -1.20, 0.64, p=0.55), or reduced length of stay (WMD -1.28, CI -2.94, 0.38, p=0.13). Similarly, nasogastric tube reinsertion was less common in traditional feeding interventions, however this was not statistically significant (OR 1.48, CI 0.93, 2.35, p=0.10). Early provision of nutritionally significant oral or enteral intake is associated with a significant reduction in reported total complications when compared with traditional postoperative feeding practices and does not negatively affect outcomes such as mortality, anastomotic dehiscence, resumption of bowel function or hospital length of stay. For these reasons, surgeons should be confident in adopting early feeding as part of standard practice for elective gastrointestinal surgery.