Early Postoperative Feeding Research Articles

A Randomized Controlled Trial of Early Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intra-abdominal Surgery

A Randomized Controlled Trial of Early Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intra-abdominal Surgery

Early postoperative enteral feeding improves whole body protein kinetics in upper gastrointestinal cancer patients

Background Patients with upper gastrointestinal (Gl) tract malignancies are at increased risk for malnutrition, as well as postoperative morbidity and mortality. As data clearly documenting the benefit of early postoperative enterai feeding in upper Gl cancer patients as compared with no feeding are sparse, we examined the protein kinetic effects of early enterai feeding and compared it with standard postoperative care (ie, intravenous fluid). Methods Twenty-nine patients undergoing resection of an upper Gl tract malignancy were prospectively randomized to either enterai feeding (FEED, n = 12) starting on postoperative day (POD) 1 via a jejunostomy tube or intravenous fluid (IVF, n = 17). On POD 5, all patients underwent resting energy expenditure determination and a protein metabolic study using the isotope 14C-leucine to determine whole body (WB, μmol leu/kg/min) protein kinetics. Results Respiratory quotient and insulin (μU/ mL) levels were significantly increased in patients receiving enterai feeding (0.85 ± 0.02,19.8 ± 4.5 versus 0.78 ± 0.02, 9.3 ± 0.8, FEED versus IVF, P < 0.05). Free fatty acids (meq/dL) were significantly lower in FEED group (0.36 ± 0.04) as compared with IVF group (0.85 ± 0.07, P < 0.0001). While there were no significant differences in WB protein oxidation (0.10 ± 0.01 versus 0.10 ± 0.02) or synthesis (0.81 ± 0.09 versus 0.68 ± 0.08, IVF versus FEED), WB protein catabolism was significantly less (0.91 ± 0.10 versus 0.37 ± 0.09, P = 0.002), and WB protein net balance was converted to positive in FEED group (−0.10 ± 0.01 versus 0.30 ± 0.03, IVF versus FEED, P < 0.001). Conclusions Early enterai feeding decreases fat oxidation and whole body protein catabolism while improving net nitrogen balance. By significantly improving protein metabolism, enteral feeding may decrease postoperative morbidity and mortality in upper Gl cancer patients.

: Economic Implications of an Early Postoperative Enteral Feeding Protocol

LEARNING OUTCOME: To list the improved outcomes and cost savings of an early postoperative feeding protocol for bowel resection patients A nonrandomized, prospective, clinical trial was conducted in which surgeons elected to participate in the treatment arm at the study's outset. A retrospective comparison group from the year prior to the study served as a baseline to evaluate contamination of the treatment to the prospective control group. Treatment (n=81) and control (n=159) patients were admitted during the same 18 month period for similar diagnoses with subsequent bowel resections at this acute care medical center hospital. Treatment patients who met specific inclusion criteria had a jejunal feeding tube placed during surgery. Tube feedings were initiated within 12 hours postoperatively. A favorable outcome was defined as each patient admission with no infectious complication. A Nonparametric Mann-Whitney-Wilcoxin Rank Sum test was utilized to determine the significance of cost differences between groups. Cost analyses utilized hospital cost accounting data. The cost of a dietitian's time was determined since it contributed incremental cost to implement the protocol. Nosocomial infections were significantly reduced by 9.6% in the treatment group (p=.042). The average variable direct cost savings per successful treatment patient was $1,474, which required an additional variable cost of $108.30 for the dietitian's time. When the cost of related readmissions was considered, the total hospital cost reduction was $368,064 for the treatment group. In conclusion, an early postoperative enteral feeding protocol as part of an outcomes management program for patients receiving bowel resection is cost-effective.

Early postoperative enteral feeding following major upper gastrointestinal surgery

For a variety of reasons, enteral feeding is frequently delayed following major abdominal surgery. The purpose of this study was to evaluate prospectively the feasibility and tolerance of early jejunal feeding following major upper gastrointestinal surgery. Beginning on postoperative day 1, patients (n = 167) received a full-strength enteral formula at the rate of 25 ml/hr through a jejunal feeding tube. Diets were advanced to the calculated target rate (25 kcal/kg/day) by postoperative day 4. Complications of tube feeding, calories received, and patient symptoms were recorded daily. There were no major complications or deaths resulting from placement of a jejunal tube or from early enteral feeding. Patients had abdominal symptoms such as cramping, distention, nausea, and diarrhea on 9%, 18%, 4%, and 24% of all feeding days, respectively. The majority of these symptoms, with the exception of diarrhea, were graded as mild. Patients undergoing surgery for pancreatic malignancy had significantly more diarrhea than patients undergoing esophagectomy or gastrectomy. Despite these differences in symptoms, patients received an average of 78% of their targeted caloric goal by postoperative day 4 and maintained this level throughout the study. Early enteral feeding for patients undergoing esophageal, gastric, or pancreatic resections is both safe and feasible despite the occurrence of predominantly mild gastrointestinal symptoms.

Factors Related to the Use of Early Postoperative Enteral Feeding in Thoracic and Abdominal Surgery Patients in the United States

Early postoperative enteral feeding uses the jejunum, which remains motile and available to absorb nutrients after surgery even while gastric and colonic ileus are present (1). Current nutrition support guidelines of the American Society for Parenteral and Enteral Nutrition (ASPEN) encourage feeding patients as soon as possible, beginning no later than 7 days after surgery. Many researchers and practitioners advocate feeding much sooner (2–9).

Enteral feeding in esophageal surgery

Malnutrition is frequently associated with esophageal cancer. To maintain and improve nutrition during the stress of esophagectomy early postoperative enteral feeding was used in surgical patients. Minor complications such as jejunal tube dislodgment, metabolic derangements, and feeding-related gastrointestinal complications occurred, all of which were easily corrected. Nutritional status was maintained or improved in most patients and the actual cost compared to a calculated cost of an equinitrogenous, equicaloric parenteral solution was much less.

Breast feeding or spoon feeding after cleft lip repair: a prospective, randomised study

It has been a tradition for plastic surgeons to withhold breast feeding from babies after cleft lip repair to prevent wound disruption. A prospective, randomised trial of 40 infants showed that early postoperative breast feeding after cleft lip repair is safe, results in more weight gain at 6 weeks after surgery (P<0.01) and is more economical than spoon feeding.

Intraoperative placement of the nasoenteric feeding tube: a practical alternative?

The provision of early postoperative enteral feeding may be enhanced by the placement of enteral feeding access during celiotomy, but surgeons are often reluctant to pursue this option because of the extra effort required. We conducted a retrospective review of our 2-year experience with 60 sequential intraoperative nasoenteric feeding-tube placements and included data on demographics, diagnosis, surgery, type of feeding tube, formula, tolerance, and complications. Our surgeons placed intraoperative nasoenteric feeding tubes at their discretion in a variety of subjects who were undergoing elective or urgent celiotomies. The surgeries largely involved the upper gastrointestinal tract, and feeding-tube placements were readily accomplished. The majority of patients received enteral feedings within 3 postoperative days and achieved feeding rates of 50 mL/h or greater. The average duration of feeding-tube use was 1 week, accounting for 399 feeding days overall. There were no serious complications attributable to feeding-tube placement or use, but inadvertent tube removal by patients or staff was a limitation. Intraoperative placement of the nasoenteric feeding tube may be a reasonable option for treating the surgical patient at nutritional risk who faces a limited course of impaired oral intake postoperatively.

Early postoperative enteral nutrition with arginine-omega-3 fatty acids and ribonucleic acid-supplemented diet versus placebo in cancer patients

To evaluate the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine, ribonucleic acid (RNA), and omega-3 fatty acids on the immune function in patients undergoing surgery for upper gastrointestinal (GI) malignancies. Prospective, randomized, placebo-controlled, double-blind study. Surgical intensive care unit (ICU) in a German university hospital. Forty-two consecutive patients receiving an enteral diet via needle catheter jejunostomy after GI surgery for cancer. Patients were randomized to receive either the arginine, RNA, and omega-3 fatty acids supplemented diet or an isocaloric and isonitrogenous placebo diet. Early enteral nutrition was started on postoperative day 1 in the surgical ICU with 20 mL/hr and progressed to the optimal goal of 80 mL/hr by postoperative day 5. Clinical examination and adverse GI symptoms were recorded on a daily basis. Body weight was determined twice weekly. Immunoglobulin concentrations were determined by laser nephelometry. Interferon-gamma concentrations were measured with a modified enzyme-linked immunosorbent assay method. Fluorescence-activated cell scan flow cytometry was performed to analyze B cells, T lymphocytes and their subsets. Clinical patient characteristics and mean caloric intake were similar between the two groups and both formulas were well tolerated. The number of T lymphocytes and their subsets, helper T cells (CD4) and activated T cells (CD3, HLA-DR), were significantly higher in the supplemented diet group on postoperative days 10 and 16 (p < .05). Mean interferon-gamma concentration after phytohemagglutinin stimulation was higher in the supplemented diet group on postoperative day 16. In the supplemented diet group, mean immunoglobulin M concentrations were significantly higher on postoperative day 10 and mean immunoglobulin G concentrations were higher on postoperative day 16 (p < .05) compared with the results in the placebo group. B-lymphocyte indices were significantly higher in the supplemented vs. the placebo diet group on postoperative days 7 and 10 (p < .05). Supplementation of enteral diet with arginine, RNA, and omega-3 fatty acids in the early postoperative time period improves postoperative immunologic responses and helps to overcome more rapidly the immunologic depression after surgical trauma.

Early Oral Feeding after Total Laryngectomy

Following total laryngectomy, 110 patients were orally fed on the first/second postoperative day without using a nasogastric (NG) tube. Pharyngo-cutaneous fistula was observed in 23 patients (21%) only nine of which (8%) needed surgical intervention to close the fistula. Early postoperative oral feeding of laryngectomized patients does not increase the fistula rate but decreases postoperative hospitalization time and eliminates the disadvantages of the NG tube.

Early postoperative feeding.

Our intent was to show that immediate postoperative feeding of a regular diet after elective colorectal surgery was safe, tolerable, and feasible. This was a nonrandomized, prospective study of 38 consecutive patients who underwent elective colorectal surgery over a three-month period. Our study parameters included operative length of time, intraoperative blood loss, need for transfusions, day to flatus or defecation, ability to tolerate a diet, placement of nasogastric tubes postoperatively, and length of hospital stay. These patients were compared with patients treated by different surgeons during the same time period but fed only after return of bowel sounds or flatus. Thirty-one of 36 patients eventually included in this study were able to tolerate our early feeding regimen. There were a total of seven other complications that were minor and unrelated to the early feeding. Patients who tolerated early feeding had shorter postoperative length of stays, 5.7 vs. 10.6 days. Patients who tolerated early feeding had shorter length of stays than patients treated in a more conventional manner, 5.7 vs. 8.0 days. Those who did not tolerate early feeding had longer procedures and greater intraoperative blood loss. Early postoperative feeding is safe and is tolerated by the majority of patients. Early feeding, if tolerated, decreases length of hospital stay and may decrease health care costs. Longer operative time and increased blood loss intraoperatively may indicate a more difficult procedure and identify those patients who will not tolerate early feeding.

Effectiveness of early postoperative feeding for major elective abdominal surgery utilizing a patient controlled diet

The objective of this study was to determine the effect of patient controlled diet progression, after major elective abdominal surgery, on length of hospital stay (LOS). The population of this study included 56 patients undergoing major open elective intra-abdominal surgery. Nutritional consults and information regarding the patient controlled diet (PCD), was completed and discussed with all patients prior to surgery. After surgery, irregardless of bowel sounds, patients were to start with clear liquids as desired and then to progress with their diet under their own control with respect to quantity and type of oral intake. Calorie counts were used to monitor patients' intake until they were discharged. Patients were further monitored for symptoms of nausea and vomiting, need for naso-gastric (NG) tube and other medical complications. LOS was noted.

Enteral feeding in the critically injured patient.

Metabolic support is an integral component in the care of the critically injured patient. When hypermetabolism occurs, there are increases in energy demands along with changes in substrate utilization. This article reviews the prospective randomized clinical trials that were undertaken at Denver General Hospital over the past decade that address both the timing of nutritional support and the route of administration in this critically injured population. Also discussed is a review of a meta-analysis that attests to the feasibility of early postoperative enteral feeding with the possibility of decreased septic morbidity in high-risk surgical patients. With the clinical knowledge gained from these trials, an algorithm for nutritional intervention was developed that represents our current standard of practice.

Early Postoperative Feeding - a Continuing Controversy in Pyloric Stenosis

Early Postoperative Feeding - a Continuing Controversy in Pyloric Stenosis

Early Postoperative Feeding - A Continuing Controversy in Pyloric Stenosis

Two regimens of postoperative fluid management are currently used following pyloromyotomy. Both early or delayed feeding have their advocates. The present study reviews 127 infants managed by the early feeding regimen. Although vomiting was common (79%) early discharge (75% within 72 h) was followed by no adverse effects. Weight gain at 7 days was unaffected by postoperative vomiting. Early feeding and early discharge can be achieved without increase in morbidity and may be the preferred method of postoperative management.

Enteral versus Parenteral Nutritional Support following Laparotomy for Trauma: A Randomized Prospective Trial

Although enteral nutrition is considered more 'physiologic' than parenteral nutrition, there is greater published experience with parenteral nutrition in trauma patients. To compare the efficacy of these two techniques, we prospectively randomized multiple trauma patients during their admission laparotomy to receive either central venous parenteral nutritional (TPN: n = 23) or enteral nutrition by jejunostomy (Jej: n = 23). Nutritional support began on the first postoperative day; the study period continued a maximum of 14 days. There were no significant differences between the two groups in age, sex, injury severity, estimated caloric needs (3,322 TPN; 3,114 Jej), hours to achieve full prescription (77 PTN; 79 Jej), or the number of days on nutritional support (22 TPN; 25 Jej). Average daily caloric intakes, nitrogen balance results, and complication rates were also comparable. These results suggest that early postoperative jejunostomy feeding is a safe and efficacious choice for multiple trauma patients undergoing laparotomy.

A nonelemental versus an elemental diet for early postoperative enteral feeding by needle catheter jejunostomy

In a prospective randomised study the use of an elemental versus a nonelemental diet for early postoperative enteral feeding by needle catheter jejunostomy was investigated. After extensive gastrointestinal surgery, 25 patients received an elemental and 24 patients a nonelemental diet. The incidence of diarrhoea, the effects of the feeding and the costs were evaluated. The occurrence of diarrhoea was observed more frequently in the elemental diet group ( 14 25 ) compared to the nonelemental diet group ( 7 24 ), although this difference was statistically not significant (p > 0.05). No difference was found between the two groups in postoperative restoration of total protein and serum albumin levels and the extent of the postoperative weight loss. The costs showed a clear difference: the nonelemental diet was three times cheaper than the elemental diet. For early postoperative enteral feeding by needle catheter jejunostomy we therefore recommend the use of a nonelemental diet.

Limited efficacy of early postoperative jejunal feeding

Twenty patients underwent placement of a jejunal catheter for early postoperative feeding at the time of upper abdominal operations, and a control group of 11 patients underwent operative procedures of similar magnitude without jejunostomy. Advancement of the rate of feeding to target intake over 6 to 7 days was attempted. Complications from the feeding led to cessation or curtailment of intake in 65 percent of the patients. Specific complications included abdominal pain and distention, diarrhea, and retrograde reflux of the feeding into the stomach. No statistically significant difference in nitrogen balance was demonstrated between the fed and unfed groups, presumably due to the limitations of nutrient delivery or absorption in the fed groups or elevated breath hydrogen excretion in patients with abdominal pain and distention suggests that the nature of the nutrients, particularly complex carbohydrates, is a factor in the development of feeding complications. Caution must be exercised in advancing the rate of postoperative jejunal feeding.

Early postoperative enteral feeding through a needle catheter jejunostomy: D. Berger and M. Roulet. Z Kinderchir 39:328–331, (October), 1984

Early postoperative enteral feeding through a needle catheter jejunostomy: D. Berger and M. Roulet. Z Kinderchir 39:328–331, (October), 1984

Early Postoperative Enteral Feeding Through a Needle Catheter Jejunostomy*

The advantages of early postoperative enteral nutrition through a needle catheter jejunostomy in 13 operated children (1 day to 14 years) are analysed. They presented various surgical or medical diseases. 8 of them had a duodenal atresia or stenosis. Their postoperative follow-up was compared with other children suffering from the same pathology without early postoperative enteral feeding. The simplicity of the realimentation, the absence of septic complications and the metabolic advantages of this method prove to be extremely efficient when a protein and calorie malnutrition must be avoided and fractionated oral feeding is impossible.