P245: Does routine nasogastric tube placement after an operation for perforated appendicitis make a difference?

Abstract

Background: Divergent opinions exist regarding the routine use of nasogastric (NG) tubes in the postoperative management of patients undergoing abdominal surgery. Empiric use of an NG tube after abdominal surgery is presumed to prevent abdominal distension, vomiting, and ileus which may complicate the postoperative course. To investigate the validity of this assumption, we compared the postoperative course of patients who underwent appendectomy for perforated appendicitis that subsequently either had or did not have an NG tube placed postoperatively. Methods: A retrospective chart review of all children operated on for perforated appendicitis between 1999 and 2004 was performed. Patients with prolonged hospitalizations were excluded to eliminate bias created by patients with multiple operations and opportunities for NG placement. The use of an NG tube, time to first and to full oral feeds, length of hospitalization, and use of parenteral nutrition were compared between groups. Results: Patients with NG tubes left in place (N = 105) were compared to those who did not receive an NG tube (N = 54) following appendectomy perforated appendicitis. Mean time to first oral intake was 3.8 days in those with NG tubes compared to 2.2 days in those without NG tubes (P < 0.001). Similarly, mean time to full feeds was 4.9 days when an NG tube was left compared to 3.4 days in those without tubes (P < 0.001). Mean length of stay was 6.0 days in those with NG tubes compared to 5.6 days in those without (P = 0.002). When length of stay was controlled by analyzing only patients with a 5 day hospital stay to compare patients with a similar degree of illness, the difference in time to first feeds and full feeds was still significantly lower in those without NG tubes. Conclusions: The omission of NG decompression after an operation for perforated appendicitis appears to cause no detriment, and there maybe some benefit to avoiding an NG tube. Therefore, we recommend that a post-operative NG tube not be routinely utilized in this patient population.