Early versus traditional postoperative nutritional provision in gastrointestinal resectional surgery patients: a meta-analysis

Early versus traditional postoperative nutritional provision in gastrointestinal resectional surgery patients: a meta-analysis

The purpose of the current work was to conduct a meta-analysis of randomized controlled trials evaluating the effect on surgical outcomes of providing nutrition within 24-hours following gastrointestinal or abdominal surgery compared with traditional postoperative management. A search of all available electronic databases was conducted to identify randomized controlled trials published comparing the outcomes of early and traditional postoperative feeding. Trials involving resection of portions of the gastrointestinal tract followed by patients receiving nutritionally significant oral or enteral intake within 24-hours after surgery were included for analysis. Random effects meta-analyses were performed. Outcome variables analysed were mortality, total complications, anastomotic dehiscence, length of stay, nausea and vomiting, nasogastric tube reinsertion, days to passing flatus, and days to first bowel motion. Fifteen studies involving a total of 1240 patients were analysed. A significant reduction in relative odds of developing post operative complications was seen in patients receiving early postoperative feeding (Odds Ratio (OR) 0.55; 95% Confidence Interval (CI) 0.35, 0.87; p=0.01). Trends favouring early feeding were seen with relation to reduction in mortality (OR 0.71; CI 0.32, 1.56; p= 0.39), anastomotic dehiscence (OR 0.75; CI 0.39, 1.4; p=0.39), length of stay (Weighted Mean Difference (WMD) -1.28; CI -2.94, 0.38; p=0.13), development of nausea and vomiting (OR0.93, CI 0.53, 1.65), resumption of bowel function as evidenced by days to passage of flatus (WMD -0.42; CI -1.12, 0.28; p=0.23) and first bowel motion (WMD -0.28; CI -1.20, 0.64; p=0.55) however these were not statistically significant. A forty-eight percent relative increase in nasogastric tube reinsertion was seen with early feeding practices (OR 1.48; CI 0.93, 2.35; p=0.10). Early provision of nutritionally significant oral or enteral intake appears to be associated with a significant reduction in reported complications when compared with traditional postoperative feeding practices and might confer reductions in mortality, anastomotic dehiscence, and resumption of gastrointestinal function as evidenced by passage of flatus. Based on the current evidence, surgeons can be reassured regarding the safety of early postoperative feeding. The widespread adoption of this evidence-based practice would be anticipated to translate to better perioperative outcomes for patients undergoing elective surgical procedures and more cost-effective management strategies for the institutions providing surgical care.