Ultra-early postoperative feeding and its impact on reducing endovenous fluids.

Anna Carolina Franco,José Eduardo Aguilar-Nascimento,Talissa Bandeira Santos,Alberto Bicudo-Salomão,Renan Vicente Sohn

doi:10.1590/0100-6991e-20202356

Abstract

To investigate the use of "ultra-early" postoperative feeding (oral liquid diet offered in the post-anesthetic recovery room) in patients undergoing common general surgical procedures and to assess the volume of intravenous fluids, as well as the rate of complications and the length of hospital stay. Prospective, observational study, which assessed the compliance with the "ultra-early" feeding, the reduction of preoperative fasting time, the perioperative venous hydration volume, the length of stay and the operative morbidity. 154 patients with a mean age of 46 ± 15 years were followed. "Ultra-early" feeding was performed in 144 cases (93.5%). Patients who did not receive the "ultra-early" feeding received a significantly greater volume of postoperative intravenous fluids (500mL versus 200mL, p = 0.018). The length of stay was 2.4 ± 2.79 days (conventional feeding) versus 1.45 ± 1.83 days ("ultra-early" feeding), with no statistical difference (p = 0.133). There was no difference in the percentage of general complications (p = 0.291), vomiting (p = 0.696) or surgical infection (p = 0.534). "Ultra-early" feeding had a high adherence by patients undergoing common general surgical procedures, and it was related to decreased infusion of postoperative fluids. Complication rates and the length of stay were similar between groups.

Highlights

Multimodal perioperative care protocols have been used by several surgical services aiming to reduce operative morbidity, length hospital stay and, accelerate the recovery of surgical patients[1,2]
The patient remains in post-anesthetic recovery unit (PAR) until his/ her complete stabilization and, immediately after he/she is discharged by the responsible anesthesiologist, he/she is offered 400mL of clear liquids, enriched with 12.5% of maltodextrin (50g)
The present study demonstrates that patients undergoing common general surgical procedures, who follow the ACERTO multimodal protocol and who were treated by the “ultraearly” postoperative feeding, while still in the PAR unit, receive decrease intravenous hydration in the postoperative period

Summary

Introduction

Multimodal perioperative care protocols have been used by several surgical services aiming to reduce operative morbidity, length hospital stay and, accelerate the recovery of surgical patients[1,2]. The ACERTO protocol (Acceleration of Total Recovery in the postoperative period), initially implemented in Brazil in 20053, has been the motto for the publication of several studies in the last decade. Three topics should be highlighted: the reduction of preoperative fasting, the perioperative venous hydration and the early postoperative feeding, all of which have a high impact on reducing the response to trauma and the length of hospital stay[4,5,6,7,8]. At the Júlio Müller University Hospital (Cuiabá, Mato Grosso, Brazil), where the ACERTO protocol was created, “ultra-early” postoperative feeding has been proposed since 2015, for patients undergoing standard general surgical procedures, while still in the post-surgery recovery unit. The patient remains in post-anesthetic recovery unit (PAR) until his/ her complete stabilization and, immediately after he/she is discharged by the responsible anesthesiologist, he/she is offered 400mL of clear liquids, enriched with 12.5% of maltodextrin (50g)

Methods

Findings

Discussion

Conclusion