Exploring the Differences Between Early and Traditional Diet Advancement in Postoperative Feeding Outcomes in Patients With an Ileostomy or Colostomy

Abstract

Background:We assessed the differences in postoperative feeding outcomes when comparing early and traditional diet advancement in patients who had an ostomy creation. Methods: At a U.S. tertiary care hospital, data from patients who underwent an ileostomy or colostomy creation from June 1, 2013, to April 30, 2017 were extracted from an institutional database. Patients who received early diet advancement (postoperative days 0 and 1) were compared with traditional diet advancement (postoperative day 2 and later) for demographics, preoperative risk factors, and operative features. The postoperative feeding outcomes included time to first flatus and ostomy output. Mann-Whitney U tests determined bivariate differences in postoperative feeding outcomes between groups. Poisson regression was used to adjust for unequal baseline characteristics. Results: Data from 255 patients were included; 204 (80.0%) received early diet advancement, and 51 (20.0%) had traditional diet advancement. Time to first flatus and time to first ostomy output were significantly shorter in the early compared with traditional diet advancement group (median difference of 1 day for both flatus and ostomy output, P < 0.001). Adjusting for baseline group differences (American Society for Anesthesiology Physical Status Classification System, surgical approach, resection and ostomy type) maintained the significant findings for both time to first flatus (β = 1.32, P = 0.01) and time to first ostomy output (β = 1.41, P < 0.001). Conclusions: Early diet advancement is associated with earlier return of flatus and first ostomy output compared with traditional diet advancement after the creation of an ileostomy or colostomy. (Nutr Clin Pract. 2019;34:631-638)

Nutrition therapy in the critically injured adult patient: A Western Trauma Association critical decisions algorithm

“…(28) The need for ongoing vasopressor support is not an absolute contraindication to the initiation of EN or an indication for PN. (discussed below in Section C) There are relatively fewer contraindications to EN than historically believed and we advocate for a trial of EN in most patients including those with an open abdomen after damage control laparotomy (17,29,30), newly created ostomy (31), those who require prone positioning (32)(33)(34) neuromuscular blockade infusions (34,35), and in patients with traumatic brain injury (TBI) (36, 37). Previous studies have not only shown EN to be safe, but even advantageous for these patients.…”

Risk factors of early postoperative bowel obstruction for patients undergoing selective colorectal surgeries

“…A meta-analysis [ 30 ] evaluating the effect on the early time of oral feeding after upper gastrointestinal surgery found that early postoperative oral feeding reduced the length of hospital stay and decreased relevant complications as anastomotic leak and incidence of nasogastric tube reinsertion. Toledano et al [ 31 ] showed that early oral feeding reduced the time to first flatus and first ostomy output compared with traditional diet in the patients who had an ostomy creation, which may promote the recovery of bowel function. In our study, time to first postoperative feeding was an independent risk factor of early postoperative bowel obstruction.…”

Risk Factors of Early Postoperative Bowel Obstruction for Patients Undergoing Selective Colorectal Surgeries

“…A meta-analysis[28] evaluating the effect on the early time of oral feeding after upper gastrointestinal surgery found that early postoperative oral feeding reduced the length of hospital stay and decreased relevant complications as anastomotic leak and incidence of nasogastric tube reinsertion. Sabrina Toledano et al [29] showed that early oral feeding reduced the time to rst atus and rst ostomy output compared with traditional diet in the patients who had an ostomy creation, which may promote the recovery of bowel function. In our study, time to rst postoperative feeding was an independent risk factor of early postoperative bowel obstruction.…”