Early vs Late Oral Feeding After GI Surgery

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

Authors: Willcutts KF, Chung MC, Erenberg CL, Finn KL, Schirmer BD, Byham-Gray LD

Ann Surg. 2016;264:54-63

Is early oral feeding superior to traditional NPO (nothing by mouth) in the postoperative period following upper gastrointestinal surgery? The authors of this study reviewed published literature covering 2112 adults in 15 studies comparing early versus late feeding protocols. The main endpoint was hospital length of stay, which was 1.72 days shorter in the early feeding group. The results were similar for the summary estimates of overall length of stay and for postoperative length of stay. No differences were seen in the overall frequency of anastomotic leak, nasogastric tube reinsertion, reoperation, readmission, or mortality.

Viewpoint

Throughout most of the 20th century, surgeons restricted postoperative dietary intake, based on the untested belief that the gastrointestinal tract needed to rest for a few days after gastrointestinal surgery. This report, based on evidence from a combination of studies, disputes that hypothesis. Early feeding is not only safe, but it actually shortens hospital length of stay without increasing the frequency of postoperative complications. It is reassuring that early oral feeding didn’t lead to an increased frequency of nausea or vomiting. The conclusions of this report, which focused on patients undergoing upper digestive tract surgery, reinforce the results of similar studies that have looked at early postoperative oral feeding.