Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications

Herbert, Georgia; Perry, Rachel; Andersen, Henning; Atkinson, Charlotte; Penfold, Chris; Lewis, Stephen J.; Ness, Andrew R; Thomas, Steven J.

doi:10.1002/14651858.cd004080.pub3

Cited by 53 publications

(74 citation statements)

References 134 publications

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“…18,19,20,21,22,23,24,25 Primary information regarding each of these eight RCTs was abstracted directly from the publications cited above. Additional information on three RCTs 22,23,25 were available from the systematic review by Herbert et al 6 Herbert et al obtained these additional details by direct correspondence with the authors of these three RCTs.…”

Section: Literature Search and Study Selectionmentioning

confidence: 99%

“…5 However, the most comprehensive systematic review and meta-analysis conducted by leading experts on the topic, updated in 2019, failed to confirm any of these previously reported important clinical benefits. 6 All of these previous meta-analyses based their conclusions on a pooled assessment of protein-containing diets with non-protein liquid diets.…”

Section: Introductionmentioning

confidence: 99%

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Early Oral Protein-Containing Diets Following Elective Lower Gastrointestinal Tract Surgery in Adults: A Meta-Analysis of Randomized Clinical Trials.

Heighes

Simpson

et al. 2020

Preprint

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Background: Although current guidelines make consensus recommendations for the early resumption of oral intake after surgery, a recent comprehensive meta-analysis failed to identify any patient-centred benefits. We hypothesized this finding was attributable to pooling studies providing effective protein-containing diets with ineffective non-protein liquid diets. Therefore, the aim of this paper was to investigate the safety and efficacy of early oral protein-containing diets versus later (traditional) feeding after elective lower gastrointestinal tract surgery in adults. Methods: PubMed, Embase and the China National Knowledge Infrastructure databases were searched from inception until 1 August 2019. Reference lists of retrieved studies were hand searched to identify randomized clinical trials reporting mortality. No language restrictions were applied. Study selection, risk of bias appraisal and data abstraction were undertaken independently by two authors. Disagreements were settled by obtaining an opinion of a third author. Majority decisions prevailed. After assessment of underlying assumptions, a fixed-effects method was used for analysis. The primary outcome was mortality. Secondary outcomes included surgical site infections, postoperative nausea and vomiting, serious postoperative complications and other key measures of safety and efficacy . Results: Eight randomized clinical trials recruiting 657 patients were included. Compared with later (traditional) feeding, commencing an early oral protein-containing diet resulted in a statistically significant reduction in mortality (Odds Ratio [OR] 0.31, P =0.02, I 2 =0%). An early oral protein-containing diet also significantly reduced surgical site infections (OR 0.39, P =0.002, I 2 =32%), postoperative nausea and vomiting (OR 0.62, P =0.04, I 2 =37%), serious postoperative complications (OR 0.60, P =0.01, I 2 =25%) and significantly improved other major outcomes. No harms attributable to an early oral protein-containing diet were identified. Conclusions: The results of this systematic review can be used to upgrade current guideline statements to a Grade A recommendation supporting an oral protein-containing diet commenced before the end of postoperative day 1 after elective lower gastrointestinal surgery in adults.

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Section: Literature Search and Study Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early Oral Protein-Containing Diets Following Elective Lower Gastrointestinal Tract Surgery in Adults: A Meta-Analysis of Randomized Clinical Trials.

Heighes

Simpson

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…(2) However, research evidence on clinical outcomes data to support this recommendation are currently limited. (14) ONS use in general hospitalized populations is variable between hospitals and it's use early during the postoperative period is currently not routine standard of care. Prior small randomized controlled trials and older meta-analysis of such trials show initial benefits of early oral feeding (on postoperative day (POD) 1)(14) versus delayed feeding, on outcomes for patients undergoing GI surgery.…”

Section: Introductionmentioning

confidence: 99%

“…The more recent Cochrane review of early post-operative nutrition in lower GI surgery continues to indicate promise of early nutrition delivery for improved clinical outcomes, but indicates additional data is urgently needed. (14) Additional meta-analysis data has examined the specific use of perioperative immunonutrition (arginine-containing ONS). These data from have consistently shown benefit of perioperative immunonutrition primarily on infectious outcomes.…”

Section: Introductionmentioning

confidence: 99%

Impact of Early Postoperative Oral Nutritional Supplement Utilization on Clinical Outcomes in Colorectal Surgery

Williams

Ohnuma

Krishnamoorthy

et al. 2020

Preprint

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Background: Small randomized trials of early postoperative oral nutritional supplementation (ONS) suggest various health benefits following colorectal surgery (CRS). However, real-world evidence of the impact of early ONS on clinical outcomes in CRS is lacking.Methods: Using a nationwide administrative-financial database (Premier Healthcare Database), we examined the association between early ONS use and postoperative clinical outcomes in patients undergoing elective open or laparoscopic CRS between 2008–2014. Early ONS was defined as the presence of charges for ONS before postoperative day (POD) 3. The primary outcome was composite infectious complications. Key secondary efficacy (intensive care unit (ICU) admission and gastrointestinal complications) and falsification (blood transfusion and myocardial infarction) outcomes were also examined. Propensity score matching was used to assemble patient groups that were comparable at baseline and differences in outcomes were examined.Results: Overall, patients receiving early ONS were older with greater comorbidities, and more likely to be Medicare beneficiaries with malnutrition. In a well-matched sample of early-ONS recipients (n=267) versus non-recipients (n= 534), infectious complications were significantly lower in early-ONS recipients (6.7% vs. 11.8%, P<0.03). Early-ONS use was also associated with significantly reduced rates of pneumonia (P<0.04), ICU admissions (P<0.04), and gastrointestinal complications (P<0.05). There were no significant differences in falsification outcomes. Conclusions: Although early postoperative ONS after CRS was more likely to be utilized in elderly patients with greater comorbidities, use of early ONS was associated with reduced infectious complications, pneumonia, ICU admission, and gastrointestinal complications. This propensity-score matched study using real-world data suggests that clinical outcomes are improved with early ONS use, a simple and inexpensive intervention in CRS patients.

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“…(2) However, research evidence on clinical outcomes data to support this recommendation are currently limited. (14) ONS use in general hospitalized populations is variable between hospitals and it's use early during the postoperative period is currently not routine standard of care. Prior small randomized controlled trials and older meta-analysis of such trials show initial bene ts of early oral feeding (on postoperative day (POD) 1)(14) versus delayed feeding, on outcomes for patients undergoing GI surgery.…”

Section: Introductionmentioning

confidence: 99%

Impact of Early Postoperative Oral Nutritional Supplement Utilization on Clinical Outcomes in Colorectal Surgery

Williams

Ohnuma

Krishnamoorthy

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background: Small randomized trials of early postoperative oral nutritional supplementation (ONS) suggest various health benefits following colorectal surgery (CRS). However, real-world evidence of the impact of early ONS on clinical outcomes in CRS is lacking. Methods: Using a nationwide administrative-financial database (Premier Healthcare Database), we examined the association between early ONS use and postoperative clinical outcomes in patients undergoing elective open or laparoscopic CRS between 2008–2014. Early ONS was defined as the presence of charges for ONS before postoperative day (POD) 3. The primary outcome was composite infectious complications. Key secondary efficacy (intensive care unit (ICU) admission and gastrointestinal complications) and falsification (blood transfusion and myocardial infarction) outcomes were also examined. Propensity score matching was used to assemble patient groups that were comparable at baseline and differences in outcomes were examined.Results: Overall, patients receiving early ONS were older with greater comorbidities, and more likely to be Medicare beneficiaries with malnutrition. In a well-matched sample of early-ONS recipients (n=267) versus non-recipients (n= 534), infectious complications were significantly lower in early-ONS recipients (6.7% vs. 11.8%, P<0.03). Early-ONS use was also associated with significantly reduced rates of pneumonia (P<0.04), ICU admissions (P<0.04), and gastrointestinal complications (P<0.05). There were no significant differences in falsification outcomes. Conclusions: Although early postoperative ONS after CRS was more likely to be utilized in elderly patients with greater comorbidities, use of early ONS was associated with reduced infectious complications, pneumonia, ICU admission, and gastrointestinal complications. This propensity-score matched study using real-world data suggests that clinical outcomes are improved with early ONS use, a simple and inexpensive intervention in CRS patients.

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Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications

Cited by 53 publications

References 134 publications

Early Oral Protein-Containing Diets Following Elective Lower Gastrointestinal Tract Surgery in Adults: A Meta-Analysis of Randomized Clinical Trials.

Early Oral Protein-Containing Diets Following Elective Lower Gastrointestinal Tract Surgery in Adults: A Meta-Analysis of Randomized Clinical Trials.

Impact of Early Postoperative Oral Nutritional Supplement Utilization on Clinical Outcomes in Colorectal Surgery

Impact of Early Postoperative Oral Nutritional Supplement Utilization on Clinical Outcomes in Colorectal Surgery

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