Early Feeding Is Feasible after Emergency Gastrointestinal Surgery

Abstract

PurposeThis study was undertaken to assess the feasibility of early feeding in patients that have undergone emergency gastrointestinal (GI) surgery.Materials and MethodsThe authors retrospectively reviewed 84 patients that underwent emergency bowel resection and/or anastomosis from March 2008 to December 2011. Patients with severe shock, intestinal ischemia, sustained bowel perforation, or short bowel syndrome were excluded. Patients were divided into the early (group E; n=44) or late (group L; n=40) group according to the time of feeding commencement. Early feeding was defined as enteral feeding that started within 48 hours after surgery. Early and late feeding groups were compared with respect to clinical data and surgical outcomes.ResultsThe most common cause of operation was bowel perforation, and the small bowel was the most commonly involved site. No significant intergroup differences were found for causes, sites, or types of operation. However, length of stay (LOS) in the intensive care unit (1 day vs. 2 days, p=0.038) and LOS in the hospital after surgery were significantly greater (9 days vs. 12 days, p=0.012) in group L than group E; pulmonary complications were also significantly more common (13.6% vs. 47.5%, p=0.001) in group L than group E.ConclusionAfter emergency GI surgery, early feeding may be feasible in patients without severe shock or bowel anastomosis instability.

Improving the quality of nurse‐influenced patient care in the intensive care unit

“…timing, volume, assessment of nutritional efficacy, tolerance to feeding and method of nutrition delivery (McClave et al , ). Randomized controlled trials and meta‐analyses have shown improved patient outcomes when enteral nutrition was delivered within 24–48 h of admission to ICU (Marik and Zaloga, ; Doig et al , ; Khalid et al , ; Chiang et al , ; Vicic et al , ; Lee et al , ; Li et al , ; Kim et al , ; Yin et al , ; McClave et al , ). Specifically, there was a significant reduction in mortality and infectious complications across multiple patient populations (Marik and Zaloga, ; Doig et al , ; Khalid et al , ; McClave et al , ).…”

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“…(13) Já está estabelecido na literatura que a instituição precoce e adequada da TN pode diminuir a morbidade de pacientes graves em UTI. (1)(2)(8)(9)(14)(15)(16)(17)(18) .…”

“…(9) Além disso, evidências revelam outros benefícios quanto ao início precoce da TNE como redução estatisticamente significativa na mortalidade e desenvolvimento de pneumonia, complicações infecciosas em geral e tempo de internação hospitalar. (14,(16)(17)(18) Gordon S. Doing et al (2009) confirmam essas evidências na meta-análise realizada sobre ensaios clínicos metodologicamente validados pela revisão sistemática da literatura, em que revelam uma redução significativa na mortalidade e pneumonia atribuível à disposição da introdução precoce da TNE no prazo de 24 horas de admissão em UTI. (19) Apesar das evidências e de especialistas ressaltarem a importância do início de TN no prazo de 24 horas a 48 horas de admissão em UTI, na prática clínica é diferente.…”

“…Em um estudo de 2013, com 38 pacientes submetidos a cirurgias urológicas ou ginecológicas, a média do tempo de jejum foi de três dias (0-7) para início de TN. (21) HyungSoon Lee et al (2014) realizaram um estudo em 84 pacientes submetidos a cirurgia gastrointestinal de urgência. A alimentação precoce foi definida como início da dieta dentro de 48 horas após cirurgia.…”

Does Diet Make a Difference Following Colon Surgery?

“…A retrospective study on 84 patients who had emergency bowel resection and/or anastomosis reported that early enteral feeding was feasible in hemodynamically stable patients [48]. A randomized trial compared early oral feeding (within 24 hours) to traditional postoperative feeds advancement and found no differences in complication rates, postoperative ileus, or length of hospital stay.…”