Early Oral Feeding as Compared With Traditional Timing of Oral Feeding After Upper Gastrointestinal Surgery: A Systematic Review and Meta-analysis

Willcutts, Kate F. DCN, RD; Chung, Mei C. PhD, MPH; Erenberg, Cheryl L. MLS; Finn, Kristen L. DCN, RD; Schirmer, Bruce D. MD; Byham-Gray, Laura D. PhD, RD

Annals of Surgery: July 2016 - Volume 264 - Issue 1 - p 54–63

doi: 10.1097/SLA.0000000000001644

Meta-Analyses

Objective: To compare the effects of early oral feeding to traditional (or late) timing of oral feeding after upper gastrointestinal surgery on clinical outcomes.

Background: Early postoperative oral feeding is becoming more common, particularly as part of multimodal or fast-track protocols. However, concerns remain about the safety of early oral feeding after upper gastrointestinal surgery.

Results: Fifteen studies comprising 2112 adult patients met all the inclusion criteria. Mean hospital stay was significantly shorter in the early-fed group than in the late-fed group [weighted mean difference = −1.72 d, 95% confidence interval (CI) −1.25 to −2.20, P < 0.01). Postoperative length of stay was also significantly shorter (weighted mean difference = −1.44 d, 95% CI −0.68 to −2.20, P < 0.01). There was no significant difference in risk of anastomotic leak, pneumonia, nasogastric tube reinsertion, reoperation, readmission, or mortality in the randomized controlled trials (RCTs). The pooled RCT and non-RCT results, however, showed a significantly lower risk of pneumonia in early-fed as compared with late-fed group (odds ratio = 0.6, 95% CI 0.41–0.89, P = 0.01).

Conclusions: Early postoperative oral feeding as compared with traditional (or late) timing is associated with shorter hospital length of stay and is not associated with an increase in clinically relevant complications.

http://journals.lww.com/annalsofsurgery/Abstract/2016/07000/Early_Oral_Feeding_as_Compared_With_Traditional.11.aspx