Comparison of multi-modal early oral nutrition for the tolerance of oral nutrition with conventional care after major abdominal surgery: a prospective, randomized, single-blind trial

Abstract

Background & aimsEarly oral nutrition (EON) has been shown to improve recovery of gastrointestinal function, length of stay and mortality after abdominal surgery; however, early oral nutrition often fails during the first week after surgery. Here, a multi-modal early oral nutrition program is introduced to promote recovery of gastrointestinal function and tolerance of oral nutrition.MethodsConsecutive patients scheduled for abdominal surgery were randomized to the multimodal EON group or a group receiving conventional care. The primary endpoint was the time of first defecation. The secondary endpoints were outcomes and the cost-effectiveness ratio in treating infectious complications. The rate of infectious-free patients was regarded as the index of effectiveness.ResultsOne hundred seven patients were randomly assigned to groups. Baseline characteristics were similar for both groups. In intention-to-treat analysis, the success rate of oral nutrition during the first week after surgery in the multimodal EON group was 44 (83.0%) versus 31 (57.4%) in the conventional care group (P = 0.004). Time to first defecation, time to flatus, recovery time of bowel sounds, and prolonged postoperative ileus were all less in the multimodal EON group (P < 0.05). The median postoperative length of stay in the multimodal EON group was 8 days (6, 12) versus 10 days (7, 18) in the conventional care group (P < 0.001). The total cost of treatment and nutritional support were also less in the multi-modal early oral nutrition group (P < 0.001). The effectiveness was 84.9 and 79.9% in the multimodal EON and conventional care group, respectively (P = 0.475). However, the cost-effectiveness ratio was USD 537.6 (506.1, 589.3) and USD 637.8 (593.9, 710.3), respectively (P < 0.001).ConclusionThe multi-modal early oral nutrition program was an effective way to improve tolerance of oral nutrition during the first week after surgery, decrease the length of stay and improve cost-effectiveness after abdominal surgery.Trial registrationRegistration number: ChiCTR-TRC-14004395. Registered 15 March 2014.

Gene–obesogenic environment interactions on body mass indices for older black and white men and women from the Health and Retirement Study

“…These findings were unexpected as several recent gene-environment studies observe a significant attenuation of PGS for BMI higher alcohol consumption compared to abstainers. 20 , 23 , 27 However, low-level alcohol use appeared to significantly attenuate the PGS effect among women in a similar manner reported in the literature. Moreover, we observed that higher alcohol consumption had a similar effect on mean BMI as alcohol abstinence across PGS levels in While men.…”

“… 22 Moreover, a prior gene-environment interaction study reported that, among women, alcohol intake associated with a higher waist circumference-adjusted BMI; however, higher polygenic risk was associated with a significantly lower body weight for these women. 23 While epidemiologic studies report that many racial/ethnic minority groups, including Black and Latino Americans, are disproportionately affected by the recent upwards obesity trends compared to Whites, these groups remain significantly underrepresented in both the GWAS and gene-environment studies of BMI, with most large cohorts consisting primarily of European-ancestry samples. 24 …”

Evaluate the compliance of perioperative practices of the patients with the enhanced recovery after surgery protocols

“…The ERAS protocol argues that liquid food on the 2nd hour and solid food intake on the 4th hour of the post-operative period should be encouraged for the patients [1]. Studies conducted in different countries indicate that the earlier oral feeding starts for the patients the shorter the time of the first defecation and the duration of hospital stay is [21,22], not the presence of anastomosis leakage and abscess and the patient satisfaction was high [23]. In laparoscopic colorectal resection surgery, in addition to preoperative oral carbohydrate administration in accordance with ERAs recommendations, patients, who switched to post-operative oral nutrition early had faster recovery of their postoperative clinical functions, decrease in recovery time and decrease in-hospital stay [24].…”

Nutrition Therapy Cost‐Effectiveness Model Indicating How Nutrition May Contribute to the Efficiency and Financial Sustainability of the Health Systems

“…Mainly, these patients presented with better nutrient intake in the first week after the operation, and time of bowel sounds, flatus, and defecation was shortened in the individuals receiving early ONS. Moreover, these patients remained in the hospital 2 days less, and the total costs were significantly decreased 59 . Sriram et al tested the effects of a nutrition‐focused quality‐improvement program (QIP) on readmissions and LOS in 4 North American hospitals.…”