The Economic Impact of Early Enteral Feeding in Gastrointestinal Surgery: A Prospective Survey of 51 Consecutive Patients

Abstract

Early postoperative oral feeding has been demonstrated to be safe and not increase postoperative morbidity. There are conflicting reports about its effect on postoperative length of stay. Some patients will fail attempts at early postoperative feeding and may be relegated to a longer postoperative course. Few studies to date have attempted to identify cost savings associated with early oral support, and those identified address nasoenteric support only. Fifty-one consecutive patients were randomized into either a traditional postoperative feeding group or an early postoperative feeding group after their gastrointestinal surgery. Length of hospital stay, hospital costs (excluding operating room costs), morbidity, and time to tolerance of a diet were compared. There was a tendency toward increased nasogastric tube use in the early feeding arm, but the morbidity rates were similar. Length of hospital stay and costs were similar in both arms. Early postoperative enteral support does not reduce hospital stay, nursing workload, or costs. It may come at a cost of higher nasogastric tube use, however, without an increase in postoperative morbidity.

Evidence for early oral feeding of patients after elective open colorectal surgery: a literature review

“…Nevertheless, it remains unclear whether vomiting and nasogastric reinsertion are more likely with early feeding. In this review, two RCTs found significant increase in both, but Lucha et al. (2005) noted only a non‐significant trend to greater nasogastric reinsertion.…”

Effect of Early vs Late Start of Oral Intake on Anastomotic Leakage Following Elective Lower Intestinal Surgery: A Systematic Review

“…Types of surgical procedures were evenly matched between groups in all studies. Laparoscopic surgery was performed only in 1 study; in other studies, open surgery was performed . When reported, there was substantial heterogeneity between studies in the use of perioperative protocols, including use of epidural anesthesia, preoperative bowel lavage, nonsteroid anti‐inflammatory drugs, and opioids.…”

“…Due to the nature of the intervention, blinding could not be applied in any study. Three studies gave no explicit description of the randomization method, resulting in an unclear risk of bias . One open‐label study used blocked randomization with a fixed block size of 6; hence, risk of selection bias was present .…”

“…Early start of oral intake is a more common form of early EN and has been extensively described as part of fast‐track protocols in colorectal surgery. Individual randomized trials have described no effect of early oral intake on AL, but most studies had a relatively small sample size and were therefore inadequately powered to detect a potential effect on AL . Previous systematic reviews on early EN also did not support an effect on AL .…”

“…In the current meta‐analysis, the pooling of all 9 randomized trials regardless of methodological quality resulted in several beneficial effects in favor of early oral intake. However, the strict exclusion of 6 studies with a modest to high risk of bias in the sensitivity analysis significantly reduced overall sample size and made the effect on AL and overall complications no longer significant. As such, the results from our study suggest that early start of oral intake is only associated with a reduction of length of stay (LOS).…”