scholarly journals Ordering a Normal Diet at the End of Surgery—Justified or Overhasty?

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1758 ◽  
Author(s):  
Fabian Grass ◽  
Martin Hübner ◽  
Jenna Lovely ◽  
Jacopo Crippa ◽  
Kellie Mathis ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Outcome Data ◽  
Normal Diet ◽  
Oral Feeding ◽  
Prolonged Length ◽  
Early Oral Feeding ◽  
American Society ◽  
Independent Decision ◽  
Recovery Pathways

Early re-alimentation is advocated by enhanced recovery pathways (ERP). This study aimed to assess compliance to ERP-set early re-alimentation policy and to compare outcomes of early fed patients and patients in whom early feeding was withhold due to the independent decision making of the surgeon. For this purpose, demographic, surgical and outcome data of all consecutive elective colorectal surgical procedures (2011–2016) were retrieved from a prospectively maintained institutional ERP database. The primary endpoint was postoperative ileus (POI). Surgical 30-day outcome and length of stay were compared between patients undergoing the pathway-intended early re-alimentation pattern and patients in whom early re-alimentation was not compliant. Out of the 7103 patients included, 1241 (17.4%) were not compliant with ERP re-alimentation. Patients with delayed re-alimentation presented with more postoperative complications (37 vs. 21%, p < 0.001) and a prolonged length of hospital stay (8 ± 7 vs. 5 ± 4 days, p < 0.001). While male gender (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.04–1.32), fluid overload (OR 1.38; 95% CI 1.16–1.65) and high American Society of Anaesthesiologists (ASA) score (OR 1.51; 95% CI 1.27–1.8) were independent risk factors for POI, laparoscopy (OR 0.51; 95% CI 0.38–0.68) and ERP compliant diet (OR 0.46; 95% CI 0.36–0.6) were both protective. Hence, this study provides further evidence of the beneficial effect of early oral feeding after colorectal surgery.

scholarly journals ENHANCED RECOVERY (ERAS) AFTER LIVER SURGERY:COMPARATIVE STUDY IN A BRAZILIAN TERCIARY CENTER

2019 ◽  
Vol 32 (1) ◽  
Author(s):  
Uirá Fernandes TEIXEIRA ◽  
Marcos Bertozzi GOLDONI ◽  
Fábio Luiz WAECHTER ◽  
José Artur SAMPAIO ◽  
Florentino Fernandes MENDES ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Surgical Stress ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Oral Feeding ◽  
Control Group ◽  
Colonic Surgery ◽  
Early Oral Feeding ◽  
Tertiary Center ◽  
Eras Protocol

ABSTRACT Background: After the publication of the first recommendations of ERAS Society regarding colonic surgery, the proposal of surgical stress reduction, maintenance of physiological functions and optimized recovery was expanded to other surgical specialties, with minimal variations. Aim: To analyze the implementation of ERAS protocols for liver surgery in a tertiary center. Methods: Fifty patients that underwent elective hepatic surgery were retrospectively evaluated, using medical records data, from June 2014 to August 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol. Results: There was no difference in age, type of hepatectomy, laparoscopic surgery and postoperative complications between the groups. In ERAS group, it was observed a reduction in preoperative fasting and in the length of hospital stay by two days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilization were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, sub-costal incision, prophylactic nasogastric intubation and abdominal drainage were more common in control group. Conclusion: Implementation of ERAS protocol is feasible and beneficial for health institutions and patients, without increasing morbidity and mortality.

scholarly journals Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 264 ◽  
Author(s):  
Ho Chiou Yi ◽  
Zuriati Ibrahim ◽  
Zalina Abu Zaid ◽  
Zulfitri ‘Azuan Mat Daud ◽  
Nor Baizura Md. Yusop ◽  
...  
Keyword(s):  
Whey Protein ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Cancer ◽  
Intervention Group ◽  
Oral Feeding ◽  
Control Group ◽  
Early Oral Feeding ◽  
Significant Difference ◽  
The Impact

Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.

Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance?

2019 ◽  
Vol 29 (4) ◽  
pp. 810-815 ◽  
Author(s):  
Basile Pache ◽  
Jonas Jurt ◽  
Fabian Grass ◽  
Martin Hübner ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Prolonged Length ◽  
Academic Center ◽  
The Impact

IntroductionEnhanced recovery after surgery (ERAS) guidelines in gynecologic surgery are a set of multiple recommendations based on the best available evidence. However, according to previous studies, maintaining high compliance is challenging in daily clinical practice. The aim of this study was to assess the impact of compliance to individual ERAS items on clinical outcomes.MethodsRetrospective cohort study of a prospectively maintained database of 446 consecutive women undergoing gynecologic oncology surgery (both open and minimally invasive) within an ERAS program from 1 October 2013 until 31 January 2017 in a tertiary academic center in Switzerland. Demographics, adherence, and outcomes were retrieved from a prospectively maintained database. Uni- and multivariate logistic regression was performed, with adjustment for confounding factors. Main outcomes were overall compliance, compliance to each individual ERAS item, and impact on post-operative complications according to Clavien classification.ResultsA total of 446 patients were included, 26.2 % (n=117) had at least one complication (Clavien I–V), and 11.4 % (n=51) had a prolonged length of hospital stay. The single independent risk factor for overall complications was intra-operative blood loss > 200 mL (OR 3.32; 95% CI 1.6 to 6.89, p=0.001). Overall compliance >70% with ERAS items (OR 0.15; 95% CI 0.03 to 0.66, p=0.12) showed a protective effect on complications. Increased compliance was also associated with a shorter length of hospital stay (OR 0.2; 95% CI 0.435 to 0.93, p=0.001).ConclusionsCompliance >70% with modifiable ERAS items was significantly associated with reduced overall complications. Best possible compliance with all ERAS items is the goal to achieve lower complication rates after gynecologic oncology surgery.

Intolerance to early oral feeding in enhanced recovery after colorectal surgery: an early red flag?

2019 ◽  
Vol 22 (1) ◽  
pp. 95-101 ◽  
Author(s):  
K. Slim ◽  
T. Reymond ◽  
J. Joris ◽  
S. Paul ◽  
B. Pereira ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Oral Feeding ◽  
Early Oral Feeding ◽  
Red Flag

scholarly journals Early Nasojejunal Nutrition Versus Early Oral Feeding in Patients After Pancreaticoduodenectomy: A Randomized Controlled Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Xinchun Liu ◽  
Qiuyang Chen ◽  
Yue Fu ◽  
Zipeng Lu ◽  
Jianmin Chen ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Surgical Complication ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Reoperation Rate ◽  
Saline Group ◽  
Oral Feeding ◽  
Complication Rates ◽  
Clinical Trial Registration ◽  
Early Oral Feeding

ObjectiveThe aim of this study was to test the hypothesis that early oral feeding (EOF) is superior to early nasojejunal nutrition (ENN) after pylorus-preserving pancreaticoduodenectomy (PPPD) in terms of delayed gastric emptying (DGE).BackgroundDGE is a common complication after PPPD. Although EOF after PPPD is recommended by several international guidelines, there is no randomized trial to support this recommendation.MethodsFrom September 2016 to December 2017, a total of 120 patients undergoing PPPD were randomized into the ENN, EOF, or saline groups at a 1:1:1 ratio (40 patients in each group). The primary endpoint was the rate of clinically relevant DGE. Secondary endpoints included overall morbidity, postoperative pancreatic fistula, post-pancreatectomy hemorrhage, abdominal infection, length of hospital stay, reoperation rate, and in-hospital mortality.ResultsThe baseline characteristics and operative parameters were comparable between the groups. The incidence of clinically relevant DGE varied significantly among the three groups (ENN, 17.5%; EOF, 10.0%; saline, 32.5%; p =0.038). The saline group had a higher clinically relevant DGE rate than the EOF group (p = 0.014). The saline group also had greater overall morbidities than the ENN and EOF groups (p = 0.041 and p = 0.006, respectively). There were no significant differences in other surgical complication rates or postoperative hospital stay. No mortality was observed in any of the groups.ConclusionsNutritional support methods were not related to DGE after PPPD. EOF was feasible and safe after PPPD, and additional ENN should not be routinely administered to patients after PPPD.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT03150615.

Safety and efficacy of early oral feeding for enhanced recovery following gastrectomy for gastric cancer: A systematic review

2019 ◽  
Vol 28 ◽  
pp. 88-95 ◽  
Author(s):  
Thaís Tweed ◽  
Yara van Eijden ◽  
Juul Tegels ◽  
Hylke Brenkman ◽  
Jelle Ruurda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Enhanced Recovery ◽  
Oral Feeding ◽  
Safety And Efficacy ◽  
Early Oral Feeding

scholarly journals The nutritional management of surgical patients: enhanced recovery after surgery

2003 ◽  
Vol 62 (4) ◽  
pp. 807-811 ◽  
Author(s):  
Kenneth C. H. Fearon ◽  
Rachel Luff
Keyword(s):  
Enhanced Recovery ◽  
Elective Surgery ◽  
Rectal Surgery ◽  
Oral Feeding ◽  
Morbidity And Mortality ◽  
Surgical Trauma ◽  
Early Recovery ◽  
Oral Nutrition ◽  
Operative Morbidity ◽  
Early Oral Feeding

Malnutrition has long been recognised as a risk factor for post-operative morbidity and mortality. Traditional metabolic and nutritional care of patients undergoing major elective surgery has emphasised pre-operative fasting and re-introduction of oral nutrition 3–5 d after surgery. Attempts to attenuate the consequent nutritional deficit and to influence post-operative morbidity and mortality have included parenteral, enteral and oral sip feeding. Recent studies have emphasised that an enhanced rate of recovery can be achieved by a multi-modal approach focused on modulating the metabolic status of the patient before (e.g. carbohydrate and fluid loading), during (e.g. epidural anaesthesia) and after (e.g. early oral feeding) surgery. Using such an approach preliminary results on patients undergoing elective colo-rectal surgery indicate a significant reduction in hospital stay (traditional care, n 48, median stay 10 d v. enhanced recovery programme, n 33, median stay 7d; P<0·01) can be achieved. Such findings emphasise the potential role of multi-modal care programmes in the promotion of early recovery from major surgical trauma.

scholarly journals Early versus Delayed Oral Feeding in Patients following Total Laryngectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Ashley Hay ◽  
Lisa Pitkin ◽  
Kurinchi Gurusamy
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Oral Feeding ◽  
Hospital Length Of Stay ◽  
Pharyngocutaneous Fistula ◽  
Early Oral Feeding ◽  
Significant Difference ◽  
Randomised Control Trials ◽  
Fistula Rate

Objectives. To assess the effects of early oral feeding in laryngectomy patients versus delayed oral feeding. The outcomes used are mortality, pharyngocutaneous fistula rate, quality of life, hospital length of stay, and complications. Method. We performed searches within five major databases until June 2013. We considered randomised control trials (RCTs) and included nonrandomised studies for the assessment of harms. Results. We included four RCTs for assessment of benefits and three nonrandomised studies for assessment of harms (393 participants). There was no statistically significant difference detected in mortality at six months, pharyngocutaneous fistulae, or complications. The length of hospital stay was shorter in the early feeding group, MD −2.72 days [95% CI −5.34 to −0.09]. Conclusion. Early oral feeding appears to have similar incidence of complications and has the potential to shorten the length of hospital stay. Further well-designed RCTs are necessary because of weakness in the available evidence.

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