Abstract
Background & aimsEarly oral nutrition (EON) has been shown to improve recovery of gastrointestinal function, length of stay and mortality after abdominal surgery; however, early oral nutrition often fails during the first week after surgery. Here, a multi-modal early oral nutrition program is introduced to promote recovery of gastrointestinal function and tolerance of oral nutrition.MethodsConsecutive patients scheduled for abdominal surgery were randomized to the multimodal EON group or a group receiving conventional care. The primary endpoint was the time of first defecation. The secondary endpoints were outcomes and the cost-effectiveness ratio in treating infectious complications. The rate of infectious-free patients was regarded as the index of effectiveness.ResultsOne hundred seven patients were randomly assigned to groups. Baseline characteristics were similar for both groups. In intention-to-treat analysis, the success rate of oral nutrition during the first week after surgery in the multimodal EON group was 44 (83.0%) versus 31 (57.4%) in the conventional care group (P = 0.004). Time to first defecation, time to flatus, recovery time of bowel sounds, and prolonged postoperative ileus were all less in the multimodal EON group (P < 0.05). The median postoperative length of stay in the multimodal EON group was 8 days (6, 12) versus 10 days (7, 18) in the conventional care group (P < 0.001). The total cost of treatment and nutritional support were also less in the multi-modal early oral nutrition group (P < 0.001). The effectiveness was 84.9 and 79.9% in the multimodal EON and conventional care group, respectively (P = 0.475). However, the cost-effectiveness ratio was USD 537.6 (506.1, 589.3) and USD 637.8 (593.9, 710.3), respectively (P < 0.001).ConclusionThe multi-modal early oral nutrition program was an effective way to improve tolerance of oral nutrition during the first week after surgery, decrease the length of stay and improve cost-effectiveness after abdominal surgery.Trial registrationRegistration number: ChiCTR-TRC-14004395. Registered 15 March 2014.
Highlights
An early start of oral nutrition is promoted in most patients undergoing abdominal surgery and is an core component that enhances recovery after surgery [1, 2]
If half of the patients were treated with the multi-modal Early oral nutrition (EON), according to a 2-sided alpha of 0.05, a sample size of 100 patients would provide more than 80% power to detect a relative reduction in the success rate of oral nutrition of 33.3% in the multi-modal early oral nutrition group compared to the conventional care group
Seventy-one patients were excluded for various reasons, resulting in 107 patients being entered into the randomized program
Summary
An early start of oral nutrition is promoted in most patients undergoing abdominal surgery and is an core component that enhances recovery after surgery [1, 2]. The early start of oral nutrition is not successful per se in all patients after major abdominal surgery [2, 3] and is commonly delayed due to gastrointestinal dysfunction, including postoperative nausea, vomiting and bloating [3]. Most of these patients have to accept total parenteral nutrition to meet nutritional requirements because of intolerance of early oral nutrition during the first week after surgery [4]. A multi-modal approach is introduced here to pave the way for early start of oral nutrition and improving gastrointestinal function. A multi-modal early oral nutrition program is introduced to promote recovery of gastrointestinal function and tolerance of oral nutrition
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