Nutritional status efficacy of early nutritional support in gastrointestinal care: A systematic review and meta-analysis

Abstract

BACKGROUND Gastrointestinal surgery is a complicated process used to treat many gastrointestinal diseases, and it is associated with a large trauma: Most patients often have different degrees of malnutrition and immune dysfunction before surgery and are prone to various infectious complications during postoperative recovery, thus affecting the efficacy of surgical treatment. Therefore, early postoperative nutritional support can provide essential nutritional supply, restore the intestinal barrier and reduce complication occurrence. However, different studies have shown different conclusions. AIM To assess whether early postoperative nutritional support can improve the nutritional status of patients based on literature search and meta-analysis. METHODS Articles comparing the effect of early nutritional support and delayed nutritional support were retrieved from PubMed, EMBASE, Springer Link, Ovid, China National Knowledge Infrastructure, China Biology Medicine databases. Notably, only randomized controlled trial articles were retrieved from the databases (from establishment date to October 2022). The risk of bias of the included articles was determined using Cochrane Risk of Bias V2.0. The outcome indicators, such as albumin, prealbumin, and total protein, after statistical intervention were combined. RESULTS Fourteen literatures with 2145 adult patients undergoing gastrointestinal surgery (1138 patients (53.1%) receiving early postoperative nutritional support and 1007 patients (46.9%) receiving traditional nutritional support or delayed nutritional support) were included in this study. Seven of the 14 studies assessed early enteral nutrition while the other seven studies assessed early oral feeding. Furthermore, six literatures had "some risk of bias," and eight literatures had "low risk". The overall quality of the included studies was good. Meta-analysis showed that patients receiving early nutritional support had slightly higher serum albumin levels, than patients receiving delayed nutritional support [MD (mean difference) = 3.51, 95%CI: -0.05 to 7.07, Z = 1.93, P = 0.05]. Also, patients receiving early nutritional support had shorter hospital stay (MD = -2.29, 95%CI: -2.89 to -1.69), Z = -7.46, P < 0.0001) shorter first defecation time (MD = -1.00, 95%CI: -1.37 to -0.64), Z = -5.42, P < 0.0001), and fewer complications (Odd ratio = 0.61, 95%CI: 0.50 to 0.76, Z = -4.52, P < 0.0001) than patients receiving delayed nutritional support. CONCLUSION Early enteral nutritional support can slightly shorten the defecation time and overall hospital stay, reduce complication incidence, and accelerate the rehabilitation process of patients undergoing gastrointestinal surgery. ...

The effect of early oral postoperative feeding on the recovery of intestinal motility after gastrointestinal surgery: a systematic review and meta-analysis of randomized clinical trials

“…By comparing the findings on complication prevention, discordant results emerged. Specifically, we found a significant reduction in the likelihood of incurring a postoperative complication, according to two previous reviews with almost similar statistically significant results [RR 0.70 compared to 0.70 ( 30 ), 0.72 ( 29 ), and 0.61 ( 28 )]. In addition, our positive results on complications are further supported by the review of Shu and colleagues ( 29 ), which showed a reduction in infectious complication rates (RR 0.50, CI95% 0.38, 0.67).…”

“…According to previous reviews, early feeding reduces LOS ( 22 , 28 , 30 ); however, we found a smaller reduction of −1.31 days compared to −1.59 days ( 30 ), −1.95 days ( 22 ), and − 2.29 days ( 28 ).…”

“…We found a similar reduction in the time to the first defecation ( 28 ) (−0.99 vs. −1 day) in the group receiving early nutritional support compared to those receiving delayed feeding ( 28 ).…”

“…Our findings were mostly consistent with the evidence available on the time to first stool passage, LOS, and vomiting, while discordant results emerged on complications. We compared our findings with those of five recently published reviews on the effectiveness of early feeding in gastrointestinal surgery ( 28 ) (14 studies), digestive tract surgery ( 29 ) (11 studies), lower gastrointestinal surgery ( 22 ) (17 studies), and colorectal surgery [7 studies ( 30 ), plus 8 of only fluids ( 27 )].…”

Comparison of different nutritional screening tools in nutritional screening of patients with cirrhosis: A cross-sectional observational study

“…Patients with liver cirrhosis have an elevated risk of deterioration of nutritional status during hospitalization, highlighting the need for special nutritional care in this patient population [ 12 ].Several studies have reported the importance of early nutritional interventions in reducing the length of hospital stays and healthcare-related costs, as well as improving quality of life [ 13 , 14 ]. However, nutrition interventions are often delayed due to failure to assess the risk of malnutrition and variations in the accuracy of screening tools [ 15 ].It can prolong the length of hospital stay, accelerate decompensation, and increase mortality [ 3 ].…”