Early Oral Intake Research Articles

Open versus laparoscopic completion cholecystectomy in patients with previous open partial cholecystectomy; a retrospective comparative study

Background: Some patients report recurrence or persistence of their manifestations after cholecystectomy, and retained gallstones may be a relevant etiology for their complaint. Completion cholecystectomy is advised for these cases to alleviate their manifestations. No previous studies have compared the outcomes of open versus laparoscopic outcomes in these patients, especially in patients who had initial open partial procedures. That is why we performed this study to report the perioperative outcomes of the two approaches in such patients. Methodology: This is a retrospective analysis of 80 patients who had a completion cholecystectomy in our center (40 open and 40 laparoscopic cases) after initial open partial cholecystectomy. Results: The duration elapsed since the primary procedure had an average of 18 months in the open group and 21 months in the laparoscopic group. Abdominal pain and dyspepsia were the most common presentations. Some patients had stump cholecystitis or jaundice. The intraoperative assessment revealed either the residual gallbladder or a long cystic duct stump. Laparoscopy yielded shorter operative time, earlier oral intake, and shorter hospitalization periods compared to the open approach (P<0.05). The latter was associated with a 20% wound infection rate that was never encountered after laparoscopy (P =0.003). Conclusion: Previous open partial cholecystectomy does not hinder subsequent laparoscopic completion cholecystectomy. Additionally, laparoscopy is associated with better perioperative outcomes than the open approach.

Clinical effect and prognosis of transoral or endoscope-assisted transoral release for irreducible atlantoaxial dislocation: A retrospective cohort study

BackgroundThe clinical applications of endoscope-assisted transoral release for irreducible atlantoaxial dislocations are limited. This study aimed to investigate the clinical effect and prognostic factors of traditional and endoscope-assisted transoral release, as well as posterior reduction and fixation, in treating irreducible atlantoaxial dislocations. Materials and methodsWe conducted a retrospective study on 59 patients with irreducible atlantoaxial dislocation who underwent either traditional or endoscope-assisted transoral release, posterior fixation, and fusion between January 2018 and January 2023. Various data, including surgical time, blood loss, drainage volume, oral intake, hospital stay, complications, and neurological status (assessed by the Japanese Orthopedic Association [JOA] score and Oswestry Disability Index [ODI]), were recorded. Imaging parameters such as the atlantodontoid interval (ADI), space available for the cord (SAC), and cervicomedullary angle (CMA) were analyzed and compared. In addition, the correlation between ODI, JOA and patient age, course of disease, preoperative ADI, SAC and CMA were analyzed. ResultsNo significant differences were observed in age, sex, BMI, preoperative ADI, preoperative SAC, or preoperative CMA. All patients achieved excellent reduction with no significant differences between the two groups. Patients in the endoscopic group experienced significantly reduced blood loss, earlier oral intake, and shorter hospital stays compared to those in the open group (P < 0.05). The ODI and JOA scores improved significantly in both groups at 1, 6, 12, 18, and 24 months postoperatively (P < 0.05). Postoperative ADI, SAC, and CMA values in both groups were significantly better than preoperative values (P < 0.001). The patient age, course of disease and the preoperative ADI were negatively correlated with the postoperative ODI and the JOA improvement ratio (P < 0.01), and the preoperative SAC and preoperative CMA had positive correlations with the postoperative ODI and the JOA improvement ratio (P < 0.01) at 6, 12 and 24 months postoperatively. ConclusionPatient age, course of disease, preoperative ADI, SAC and CMA are correlated with the operative prognosis of irreducible atlantoaxial dislocation. The endoscope-assisted transoral approach, compared to the traditional transoral approach, is minimally invasive, resulting in less operative blood loss, earlier oral intake and a shorter length of hospital stay, which could be offered as an alternative for irreducible atlantoaxial dislocation.

Effect of oral intake initiation-establishment interval on hospital stay after oral cancer surgery.

To clarify the effect of the period between initiation of oral intake (IOI) and establishment of oral intake (EOI) on length of hospital stay. This retrospective study included postoperative oral cancer patients. The number of days from surgery to IOI and EOI and between IOI and EOI were recorded. We performed intergroup comparisons and Cox regression analysis using the number of days until discharge, representing hospital stay length as the dependent variable. The median number of days between IOI and EOI was 3 days for eligible patients and 4.5 and 1.5 for older and younger patients, respectively. The median number of days from surgery to IOI was 15 days. There was a significant correlation between the period between IOI and EOI and the length of hospital stay (r = 0.40, p < 0.01). The period between IOI and EOI was a significant independent variable for the length of hospital stay (HR [95% confidence interval] = 0.45 [0.28-0.72]). Shortening the IOI to EOI intervals was identified as an independently associated factor for shortening hospital stay, even in older postoperative patients with dysphagia who struggled with early oral intake initiation. Professional, step-by-step dysphagia rehabilitation tailored to the patient's condition yields beneficial outcomes.

Robotic ambulatory colorectal resections: a systematic review.

Colorectal surgery has progressed greatly via minimally invasive techniques, laparoscopic and robotic. With the advent of ERAS protocols, patient recovery times have greatly shortened, allowing for same day discharges (SDD). Although SDD have been explored through laparoscopic colectomy reviews, no reviews surrounding robotic ambulatory colorectal resections (RACrR) exist to date. A systematic search was carried out across three databases and internet searches. Data were selected and extracted by two independent reviewers. Inclusion criteria included robotic colorectal resections with a length of hospital stay of less than one day or 24h. 4 studies comprising 136 patients were retrieved. 56% of patients were female and were aged between 21 and 89years. Main surgery indications were colorectal cancer and recurrent sigmoid diverticulitis (43% each). Most patients had low anterior resections (48%). Overall, there was a 4% complication rate postoperatively, with only 1 patient requiring readmission due to postoperative urinary retention (< 1%). Patient selection criteria involved ASA score cut-offs, nutritional status, and specific health conditions. Protocols employed shared similarities including ERAS education, transabdominal plane blocks, early removal of urinary catheters, an opioid-sparing regime, and encouraged early oral intake and ambulation prior to discharge. All 4 studies had various follow-up methods involving telemedicine, face-to-face consultations, and virtual ward teams. RACrRs is safe and feasible in a highly specific patient population; however, further high-quality studies with larger sample sizes are needed to draw more significant conclusions. Several limitations included small sample size and the potential of recall bias due to retrospective nature of 2 studies.

Treatment of Oral Lymphangiomas by Coblation.

Lymphangioma is a malformation of superficial lymphatic vessels. Tongue lymphangiomas are relatively uncommon. Multiple treatment modalities have been reported, with variable treatment responses. Most of the traditional treatment modalities have a high recurrence rate. We describe the use of coblation in the management of lymphangioma circumscriptum of the dorsum of tongue in two patients. Radiofrequency ablation of oral lymphangiomas showed early postoperative oral intake and minimal postoperative pain. There was no recurrence of disease on 1 year follow up. Improved wound healing, early postoperative oral intake and minimal postoperative pain, make radiofrequency ablation a highly valuable treatment modality for oral lymphangiomas and may be recommended as the treatment of choice.

Post-Caesarean Rehabilitation: Evaluation Of Practices

Background: Early Rehabilitation, "Fast-Track Surgery," or Enhanced Recovery After Surgery (ERAS) protocols have shown significant benefits in various surgical procedures, including caesarean sections. These protocols aim to expedite recovery, reduce hospital stays, and minimize complications through a multidisciplinary approach. Despite their proven effectiveness, the implementation of such protocols in post-caesarean recovery remains uneven and warrants further investigation. Objective: This study aims to evaluate the current practices of early post-caesarean rehabilitation, focusing on pain management, early nutritional intake, mobilization, and mother-child bonding to identify gaps and opportunities for improvement. Methods: A prospective observational multicenter study was conducted between January and April 2021 at the Maternity and Neonatology Center of Tunis and the Principal Military Hospital of Tunis. The study involved 170 parturients undergoing caesarean section under spinal anesthesia, excluding those with contraindications. Data were collected using a standardized form, covering demographic details, medical history, surgical and anesthesia details, and post-operative recovery metrics, including pain assessment (VAS scores), timing of first oral intake, mobilization, and mother-child bonding. Statistical analysis was performed using SPSS version 25. Results: The average age of parturients was 30 ± 5 years. A majority (73%) of caesarean sections were planned, with surgery durations mostly within one to two hours. Post-operative pain management revealed that 73% of parturients reported a VAS ≤ 2 at the 3rd hour, but 77% experienced a VAS ≥ 4 by the 6th hour. Early oral intake was initiated by 66% of parturients before the 6th hour for liquids and before the 12th hour for light meals. The urinary catheter was removed before the 12th postoperative hour in 56% of cases. Early mobilization was achieved by 67% of parturients before the 12th hour, and 82% were breastfeeding naturally, with 79.7% satisfaction with care. Conclusion: The study highlights the partial implementation of ERAS protocols in post-caesarean recovery, pinpointing areas for improvement, particularly in pain management, early oral intake, and mobilization. A standardized approach to early post-caesarean rehabilitation could significantly enhance maternal and neonatal outcomes, reduce complications, and improve patient satisfaction.

Early swallowing rehabilitation and promotion of total oral intake in patients with aspiration pneumonia: A retrospective study.

To investigate the impact of early swallowing assessment and rehabilitation on the total oral intake and in-hospital mortality in patients with aspiration pneumonia. We retrospectively analyzed the data of patients with aspiration admitted between September 1, 2015, and October 31, 2016. The inclusion criterion was total oral intake before admission. A new protocol-based intervention for appropriate early oral intake was implemented on April 1, 2016. The protocol consisted of two steps. First, a screening test was conducted on the day of admission to detect patients who were not at high risk of dysphagia. Second, patients underwent a modified water swallowing test and water swallowing test. Patients cleared by these tests immediately initiated oral intake. The primary outcome, the composite outcomes of no recovery to total oral intake at discharge, and in-hospital mortality were compared between the patients admitted pre- and post protocol intervention. A total of 188 patients were included in the analysis (pre-, 92; post-, 96). The primary outcome did not differ between the pre- and post-intervention periods (23/92 [25.0%] vs. 18/96 [18.8%], p = 0.30). After adjusting for other variables, the intervention was significantly associated with a lower risk of composite outcomes (odds ratio, 0.22, 95%CI, 0.08-0.61, p = 0.004). The new protocol for early swallowing assessment, rehabilitation, and promotion of oral intake in patients admitted with aspiration pneumonia may be associated with the lower risk for the composite outcomes of in-hospital mortality and no recovery to total oral intake.

Effect of modified endotracheal intubation protocol combined with early oral intake on postoperative recovery quality in thyroid and parathyroid surgery at a tertiary hospital in China: a 2x2 factorial randomised controlled trial protocol

IntroductionEarly oral intake (EOI) is supposed to be safe and beneficial to patients’ recovery. However, the optimal timing of resuming oral intake has not been validated in thyroid and parathyroid...

Effectiveness of Swallowing and Oral Care Interventions on Oral Intake and Salivary Flow of Patients Following Endotracheal Extubation at a Tertiary Care Center: A Randomized Controlled Trial.

Endotracheal intubation and mechanical ventilation are the most frequently used life-sustaining interventions in critical care. Prolonged intubation can lead to post-extubation dysphagia, affecting the individual's nutritional level and communication ability. Thereupon, this study aims to assess the effectiveness of swallowing and oral care interventions in resuming oral intake and increasing salivary flow in post-extubation patients. A randomized controlled trial was conducted in critical care units of a tertiary care setting, where 92 post-extubation patients who had undergone intubation for≥48 hours were enrolled. The intervention group received swallowing and oral interventions, including safe swallowing education (SSE), toothbrushing, salivary gland massage, oral cavity, and swallowing exercises. In contrast, the control group received standard oral care every 8th hour. Oral intake was assessed daily with the Functional Oral Intake Scale, and the salivary flow measurement was assessed with oral Schirmer's test on the 1st, 3rd, and 7th day after extubation. The baseline demographic and clinical characteristics showed that the groups were homogenous. The intervention group achieved total oral intake two days earlier than the control group. Findings also showed that the participants in the intervention group had a significant increase in salivary flow than in the control group on the 3rd and 7th days of the intervention. Swallowing and oral care interventions help post-extubation patients resume early oral intake and increase salivary flow after prolonged intubation. Hence, it improves the patient's outcome toward a healthy life.

The role of enhanced recovery after surgery (ERAS) in promoting quality improvement and patient safety in pediatric urology

Enhanced Recovery After Surgery (ERAS) is a set of evidence-based, multidisciplinary protocols that aim to improve the perioperative experience for patients by optimizing factors before, during, and after surgery. Originally developed for adult colorectal surgery, these protocols have expanded and been adopted into the pediatric surgical realm, including pediatric urology. Preoperative interventions are directed toward reducing physiologic and emotional stress prior to surgery, including preoperative education and decreased duration of fasting. Intraoperative interventions are designed to support physiologic homeostasis through maintenance of normothermia and euvolemia, use of regional anesthesia, and minimizing placement of drains. Postoperative interventions seek to reduce the physiologic burden of surgery and restore patients to their functional baseline through early oral intake, early mobilization, and opioid-sparing, multimodal analgesia. ERAS has demonstrated efficacy and safety across a wide variety of surgical subspecialties. In pediatric urology, ERAS has led to earlier return of bowel function, decreased opioid utilization, and shorter hospital length of stay, without an increase in complications compared to prior standard of care. ERAS can thus be seen as a system through which quality improvement (QI) initiatives can be designed and tailored to particular settings and patient populations. This review aims to summarize current data in pediatric urology regarding ERAS elements in the context of QI and patient safety. It will discuss the barriers and future directions of this field, including collaboration with implementation science to facilitate adoption of these protocolized measures more widely.

Association of early oral intake after extubation and independent activities of daily living at discharge among intensive care unit patients: A single centre retrospective cohort study

Purpose We investigated the association between the time to first post-extubation oral intake, barriers to oral intake, and the rate of activities of daily living (ADL) independence at discharge (Barthel Index score <70). Method Consecutive patients admitted to the intensive care unit, aged ≥18 years, and mechanically ventilated for ≥48 hr were retrospectively enrolled. The time to first oral intake, barriers to oral intake, daily changes, and clinical outcomes were assessed. Multiple logistic regression analysis adjusted for baseline characteristics was used to determine the association between time to first post-extubation oral intake and ADL independence. Result Among the 136 patients, 74 were assigned to the ADL independence group and 62 to the dependence group. The time to first post-extubation oral intake was significantly associated with ADL independence (adjusted p = < 0.001) and was a predictor of ADL independence at discharge. Respiratory and dysphagia-related factors (odds ratio [OR] 0.35; 95% confidence interval [CI] 0.15–0.82, p = 0.015 and OR 0.07; CI 0.01–0.68, p = 0.021, respectively) were significantly associated with the ADL independence at discharge. Conclusion Respiratory and dysphagia-related factors, as barriers to the initiation of oral intake after extubation, were significantly associated with ADL independence at discharge.

The Right Time for Certification

The Right Time for Certification

Immediate vs on-demand maternal oral full feeding after unplanned cesarean section during labor: a randomized controlled trial

The adoption of Enhanced Recovery After Cesarean is increasing, but evidence supporting individual interventions having a specific benefit to Enhanced Recovery After Cesarean is lacking. A key element in Enhanced Recovery After Cesarean is early oral intake. Maternal complications are more frequent in unplanned cesarean delivery. In planned cesarean delivery, immediate full feeding enhances recovery, but the effect of unplanned cesarean delivery during labor is not known. This study aimed to evaluate immediate oral full feeding vs on-demand oral full feeding after unplanned cesarean delivery in labor on vomiting and maternal satisfaction. A randomized controlled trial was conducted in a university hospital. The first participant was enrolled on October 20, 2021, the last participant was enrolled on January 14, 2023, and follow-up was completed on January 16, 2023. Women were assessed for full eligibility on arrival at the postnatal ward after their unplanned cesarean delivery. The primary outcomes were vomiting in the first 24 hours (noninferiority hypothesis and 5% noninferiority margin) and maternal satisfaction with their feeding regimen (superiority hypothesis). The secondary outcomes were time to first feed; food and beverage quantum consumed at first feed; nausea, vomiting, and bloating at 30 minutes after first feed, at 8, 16, and 24 hours after the operation, and at hospital discharge; parenteral antiemetic and opiate analgesia use; first breastfeeding and satisfactory breastfeeding, bowel sound, and flatus; second meal; cessation of intravenous fluid; removal of a urinary catheter; urination; ambulation; vomiting during the rest of hospital stay; and serious maternal complications. Data were analyzed using the t test, Mann-Whitney U test, chi-square test, Fisher exact test, and repeated measures analysis of variance as appropriate. Overall, 501 participants were randomized into immediate or on-demand oral full feeding (sandwich and beverage). Vomiting in the first 24 hours were reported by 5 of 248 participants (2.0%) in the immediate feeding group and 3 of 249 participants (1.2%) in the on-demand feeding group (relative risk, 1.7; 95% confidence interval, 0.4-6.9 [0.48%-8.28%]; P=.50), and the maternal satisfaction scores from 0 to 10 were 8 (6-9) for the immediate feeding group and 8 (6-9) for the on-demand feeding groups (P=.97). The times from cesarean delivery to the first meal were 1.9 hours (1.4-2.7) vs 4.3 hours (2.8-5.6) (P<.001), first bowel sound 2.7 hours (1.5-7.5) vs 3.5 hours (1.8-8.7) (P=.02), and second meal 7.8 hours (6.0-9.6) vs 9.7 hours (7.2-13.0) (P<.001). These intervals were shorter with immediate feeding. The participants were more likely to agree to recommend immediate feeding to a friend (228 [91.9%] in the immediate feeding group vs 210 [84.3%] in the on-demand feeding group; relative risk, 1.09; 95% confidence interval, 1.02-1.16; P=.009). However, at first feed for food, ate "nothing at all" rates were 10.4% (26/250) in the immediate group and 3.2% (8/247) in the on-demand group, and "eaten all" rates were 37.5% (93/249) in the immediate group and 42.8% (106/250) in the on-demand group (P=.02). Other secondary outcomes were not different. Compared with on-demand oral full feeding, immediate oral full feeding after unplanned cesarean delivery in labor did not increase the maternal satisfaction score and was not noninferior on postoperation vomiting. On-demand feeding with its emphasis on patient autonomy could be preferred, but the earliest full feeding should be encouraged and provided.

The application of enhanced recovery after surgery in total gastrectomy: a propensity score-matched analysis

BackgroundThis study aimed to investigate the feasibility and safety of our enhanced recovery after surgery protocol including early oral intake and omitting nasogastric tube (NGT) placement after total gastrectomy.MethodsWe analyzed 182 consecutive patients who underwent total gastrectomy. The clinical pathway was changed in 2015, and patients were divided into 2 groups (conventional group and modified group). Postoperative complications, bowel movement, and postoperative hospital stays were compared in the two groups in all cases and propensity score matching (PSM).ResultsFlatus and defecation were significantly earlier in the modified group compared with those in the conventional group (flatus: 2 (1–5) days vs 3 (2–12) days, p = 0.03; defecation: 4 (1–14) days vs 6 (2–12) days p = 0.04). The postoperative hospital stay was 18 (6–90) days in the conventional group and 14 (7–74) days in the modified group (p = 0.009). Days until discharge criteria were met were earlier in the modified group compared with that in the conventional group (10 (7–69) days vs 14 (6–84) days p = 0.01). Overall and severe complications occurred in nine patients (12.6%) and three patients (4.2%) in the conventional group and twelve patients (10.8%) and four patients (3.6%) in the modified group, respectively (p = 0.70 and p = 0.83) in all cases. In PSM, there is no significant difference between the two groups concerning the postoperative complications (overall complication 6 (12.5%) vs 8 (16.7%) p = 0.56, severe complications 1 (2%) vs 2 (4.2%) p = 0.83).ConclusionsModified ERAS for total gastrectomy may be feasible and safe.

Factors affecting polyglycolic acid sheet engraftment success for covering mucosal defects from head and neck surgery.

Polyglycolic acid (PGA) sheets have been used with fibrin glue to cover extensive mucosal defects in oral and pharyngeal surgery; however, the sheets can fall off before wound healing is completed. Hence, prolonged fasting is often recommended in such patients. However, there are few studies on the factors that shape PGA sheet engraftment. We studied sheet engraftment rates considering these factors. All consecutive cases of oral surgery in 2013-21 in which the defect was covered with fibrin glue and Neoveil® or Neoveil Nano® PGA sheets were identified. The loss of all sheets was defined as an engraftment failure. Multiple logistic regression analysis was conducted to identify whether the PGA-sheet type, application site, defect size and postoperative fasting duration predicted engraftment. Overall, 137 patients were identified (mean age, 73years; 57% male). The surgeries were conducted with Neoveil® in 66% of the patients; the most common site was the buccal mucosa (25%), and the mean defect size and fasting duration were 709mm2 and 4days, respectively. The engraftment rate was 76%. Neoveil Nano® PGA sheets were associated with a 2.8-fold better engraftment rate than Neoveil® (univariate: 87 vs. 70%, P=0.032; multivariate: 95% confidence intervals=1.067-7.410, P=0.036). Other variables, including fasting duration, were not predictive of engraftment. This is the largest case series of patients with head and neck cancer who underwent fibrin glue-PGA sheet defect coverage. The fasting duration did not influence engraftment. Therefore, early oral intake is not contraindicated in such patients.

Effects of a Mobilization Program Applied to Bariatric Surgery Patients on Preventing Gastrointestinal Complications: a Quasi-Experimental Study.

To investigate the effects of a planned early targeted mobilization program applied to patients that underwent bariatric surgery with the laparoscopic sleeve gastrectomy method on gastrointestinal complications (nausea-vomiting, abdominal distention, delayed flatus-defecation, and intolerance of early oral intake). This prospective, controlled group, quasi-experimental design study was conducted between July 2019 and March 2020 in the general surgery clinic of a training and research hospital with 70 patients who underwent sleeve gastrectomy and met the inclusion criteria. The prepared mobilization program was applied to the patients on the 0th, 1st, and 2nd postoperative days, and the gastrointestinal functions of the patients were monitored. The intervention group had a significantly shorter time to first flatus, defecation, and oral intake; higher frequency of defecation; lower pain, abdominal distention, and nausea; better tolerance of oral intake; and higher total oral intake compared to the control group (p < 0.05). Planned, early, and targeted mobilization was determined to be a feasible, safe, and cost-effective nursing intervention to prevent gastrointestinal complications in patients undergoing sleeve gastrectomy.

Ketosis in patients undergoing colonoscopy – more common than we think

ObjectiveSodium-glucose co-transporter-2 inhibitors (SGLT2i) are associated with risk of euglycemic ketoacidosis. Guidelines recommend withholding SGLT2i prior to surgery and considering procedure delay in the presence of ketosis. Literature to support this in setting of routine outpatient colonoscopy is limited. Our aim was to clarify the incidence and range of ketosis in all individuals presenting for elective colonoscopies to help setting guidelines and threshold for concern. MethodsThis single-centre prospective study recruited patients ≥18 of age who underwent routine outpatient colonoscopies in a medium metropolitan hospital in Brisbane, Australia between August and November 2021. SGLT2i were withheld for 48 h prior and blood glucose and capillary ketone concentrations were recorded within 90 minutes before procedure commencement. Results315 individuals were consecutively recruited; 179 (56.8%) were female. Sixty-nine (21.9%) had a previous diagnosis of type 2 diabetes mellitus (T2DM) and 17 (5.4%) were taking SGLT2i. The mean age was 57.79 (± 15.21). Significant ketone levels defined as >1.0 mmol/L were noted in 41 individuals (13.0%). Of these, 13 (33%) were diabetic with ketosis ranging from 1.0-4.2mmol/L. The range of significant ketosis in the 28 non-diabetics was 1.0-5.7mmol/L. Only a diagnosis of T2DM and increased fasting times (>45 mins) conferred a greater trend towards ketosis risk. Patients with T2DM as a whole were 2.06 times more likely to develop ketosis with or without SGLT2i. This did not reach statistical significance (p = 0.05). ConclusionA wide range of periprocedural ketosis commonly occurs in patients undergoing colonoscopies with or without T2DM. This phenomenon is not unique to diabetics or in those on SGLT2i. Hence, previously defined significant ketosis cut-offs are unlikely to be useful in the unique context of colonoscopies. Avoiding procedural delays and early commencement oral intake should be a priority.

Daytime-restricted parenteral feeding is associated with earlier oral intake in children following stem cell transplant

Daytime-restricted parenteral feeding is associated with earlier oral intake in children following stem cell transplant

The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study.

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients' stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.

167 - Earlier Oral Intake in Pediatric Stem Cell Transplant Patients Receiving Time-Restricted Feeding: A Prospective, Randomized Trial

167 - Earlier Oral Intake in Pediatric Stem Cell Transplant Patients Receiving Time-Restricted Feeding: A Prospective, Randomized Trial