Abstract
Enhanced recovery after surgery (ERAS) program has become the main trend in gastrointestinal surgery. This study aims to investigate factors influencing the decision-making of nasogastric tube (NGT) placement and its safety and efficacy after gastrectomy. We analyzed our prospectively maintained database including 287 patients who underwent elective gastrectomy in our department from January 1 to December 31, 2017. All cases were divided into two groups, namely, the no-NGT group and the NGT group. Logistic regression was used to analyze factors that affected the decision of NGT placement, and propensity score matching (PSM) was later applied to balance those factors for the analysis of safety outcomes between groups. Multivariate analysis showed 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 factor of NGT 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 significant differences between patients with or without NGT in postoperative hospital stay, time to first flatus and defecation, time to fluid and semi-fluid 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 was 7.0% and 9.6% (p = 0.472). The decision-making of NGT placement is mainly influenced 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.
Highlights
Enhanced recovery after surgery (ERAS) program has become the main trend in gastrointestinal surgery
We retrospectively analyzed our prospectively maintained database to explore the influence factors of the decision making of nasogastric tube placement, to evaluate whether omitting nasogastric tube accelerate the postoperative recovery of patients after gastrectomy, and last but not least, to assess whether it is safe after gastrectomy without nasogastric tube
Univariate analysis (Table 2.1) showed that resection range (p = 0.004) and lymph node dissection range (p = 0.032) were significantly correlated with nasogastric tube placement. These two, together with the preoperative pathological differentiation, clinical TNM stage, operative approach, multiple organ resection, surgeon and nasogastric tube placement required further exploration (0.05 < p < 0.2, respectively) were included in the multivariate analysis (Table 2.2), and we found that only resection range (p = 0.004) was the independent influence factor of nasogastric tube placement
Summary
Enhanced recovery after surgery (ERAS) program has become the main trend in gastrointestinal surgery. The aim of this study is to investigate factors influencing the decision-making of nasogastric tube (NGT) placement and its safety and efficacy in clinical practice. Rapid recovery after operations has gradually become clinical routine in gastrointestinal surgery. Nasogastric tube is routinely used in the majority, if not all, gastric cancer patients after gastrectomy in China. With the accumulating evidence against the routine use of nasogastric tube, it is yet unclear that what factors exactly influence the decision making of nasogastric tube placement in China. We retrospectively analyzed our prospectively maintained database to explore the influence factors of the decision making of nasogastric tube placement, to evaluate whether omitting nasogastric tube accelerate the postoperative recovery of patients after gastrectomy, and last but not least, to assess whether it is safe after gastrectomy without nasogastric tube
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