Omitting nasogastric tube placement after gastrectomy does not enhance postoperative recovery: a propensity score matched analysis

Abstract

Background: Enhanced recovery after surgery (ERAS) program has become the main trend in gastrointestinal surgery. The aim of this study is to investigate factors in uencing the decision-making of nasogastric tube (NGT) placement and its safety and e cacy in clinical practice.Methods: We analyzed our prospectively maintained database including 287 patients underwent elective gastrectomy in our department from January 1 to December 31, 2017. All cases were divided into two groups, namely, the non-nasogastric tube group and the nasogastric tube group. Logistic regression was used to analyze the factors that affect the decision of nasogastric tube placement, and propensity score matching (PSM) was later applied to balance those factors for the analysis of the safety outcomes between the groups.Results: Multivariate analysis showed that resection range ( p =0.004, proximal gastrectomy: OR=4.555, 95%CI=1.392-14.905, p =0.016; total gastrectomy: OR=1.990, 95%CI=1.205-3.287, p =0.009) was the only independent risk factors of nasogastric tube placement. NGT was omitted in the majority (58.8%) of distal gastrectomy, but only in 42.5% and 25% in total and proximal gastrectomy. After PSM, we found no signi cant differences between patients with or without NGT in postoperative hospital stay, time to rst atus and defecation, time to uid and semi-uid diet, rate of reinsertion, or hospitalization expenditure (p>0.05 respectively). The incidence of postoperative complications in the two groups were 21.7% and 23.5% respectively ( p =0.753), and the incidence of major complications were 7.0% and 9.6% ( p =0.472). Conclusions:The decision-making of NGT placement is mainly in uenced by the resection range.Omitting NGT is a safe approach in all types of gastrectomy but was not able to enhance the recovery in our practice.

Routine postoperative nasogastric or nasojejunal tube placement may be unnecessary after gastric resection

“…Tube usage still con-tinues in the postoperative period because of the prolonged operation time and the possibility of paralytic ileus. Some studies have demonstrated that using NG/NJ tubes is not required in the postoperative period, but many surgeons have been discouraged from abandoning this practice [4,8]. Patients who did not use tubes were given an oral diet earlier in the postoperative period, and no one required NG/NJ tube de-…”

“…According to research, all forms of gastric resection may be performed without the needing for an NG/NJ tube [3,8,17]. In our study, regardless of the extent of gastric resection and lymphadenectomy (D1/D2), the NG/NJ tube was not used in all patients in the non-NG/NJ tube group.…”

The application of enhanced recovery after surgery in total gastrectomy: a propensity score matched analysis

“…In this study in the modi ed group, four patients experienced postoperative ileus, and two patients required NGT reinsertion, but these patients recovered without surgery. Prolonged perioperative fasting and NGT are likely to induce nausea and delay bowel function recovery and the patients without a postoperative NGT recovered postoperative bowel movement earlier than patients with an NGT and that routine postoperative NGT intubation is unnecessary after elective surgery [14]. It is unclear whether early removal of NGT accelerates the recovery of bowel movement.…”

The application of enhanced recovery after surgery in total gastrectomy: a propensity score-matched analysis

“…In this study in the modified group, four patients experienced postoperative ileus, and two patients required NGT reinsertion, but these patients recovered without surgery. Prolonged perioperative fasting and NGT are likely to induce nausea and delay bowel function recovery, and the patients without a postoperative NGT recovered postoperative bowel movement earlier than patients with an NGT and that routine postoperative NGT intubation is unnecessary after elective surgery [ 17 ]. Although previous reports suggested omitting NGT placement does not enhance the postoperative recovery in gastric cancer [ 17 ], our modified ERAS included that omitting NGT enhanced the postoperative recovery.…”

“…Prolonged perioperative fasting and NGT are likely to induce nausea and delay bowel function recovery, and the patients without a postoperative NGT recovered postoperative bowel movement earlier than patients with an NGT and that routine postoperative NGT intubation is unnecessary after elective surgery [ 17 ]. Although previous reports suggested omitting NGT placement does not enhance the postoperative recovery in gastric cancer [ 17 ], our modified ERAS included that omitting NGT enhanced the postoperative recovery. It is speculated that this is the effect of multiple items such as early oral intake, reduction of intestinal edema due to early termination of infusion, and administration of herbal medicine: Dai-kenchu-to.…”