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Lee N, Jeong E, Park Y, Jo Y, Kim J, Jang H. Serum lactate normalization time associated with prolonged postoperative ileus after surgical management of the small bowel and/or mesenteric injuries. BMC Surg 2024; 24:94. [PMID: 38515100 PMCID: PMC10956389 DOI: 10.1186/s12893-024-02388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACK GROUND Determining the optimal timing of postoperative oral feeding in trauma patients who have undergone abdominal surgery with small bowel and/or mesenteric injuries is challenging. The aim of this study is to investigate serum lactate as a factor that can predict oral feeding tolerance and prolonged postoperative ileus (PPOI) in patients who underwent surgery for small bowel and/or mesenteric injury due to trauma. METHODS The single center retrospective observational study was conducted on 367 patients who underwent surgery for small bowel and/or mesenteric injury between January 2013 and July 2021. The patient group was divided into two groups based on whether the peak serum lactate was over 2mmol/L (18 mg/dL). In the group of lactate > 2mmol/L, it was divided into prolonged postoperative ileus (PPOI) groups and groups rather than PPOI. RESULTS Patients in the peak serum lactate > 2 group had tendency to use vasopressors, lower initial systolic blood pressure, larger number of packed red blood cells for 24 h, higher injury severity score, higher PPOI incidence, and a tendency for delayed oral intake tolerance. In peak serum lactate greater than 2 mmol/L group, the lactate normalization time (OR 1.699, p = 0.04), quantity of FFP transfusion for 24 h (OR 1.145, p = 0.012), and creatine kinase (OR 1.001, p = 0.023) were related to PPOI. The lactate normalization time had the highest correlation. CONCLUSION In patients undergoing surgical management for small bowel and/or mesenteric injury after trauma, serum lactate normalization time affects oral intake tolerance and prolongs postoperative ileus.
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Affiliation(s)
- Naa Lee
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Euisung Jeong
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Yunchul Park
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Younggoun Jo
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Jungchul Kim
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Hyunseok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, 42 Jebong- ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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Toledano S, Sackey J, Willcutts K, Parrott JS, Tomesko J, Al-Mazrou AM, Kiran RP, Brody RA. Exploring the Differences Between Early and Traditional Diet Advancement in Postoperative Feeding Outcomes in Patients With an Ileostomy or Colostomy. Nutr Clin Pract 2019; 34:631-638. [PMID: 30690780 DOI: 10.1002/ncp.10245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We assessed the differences in postoperative feeding outcomes when comparing early and traditional diet advancement in patients who had an ostomy creation. METHODS At a U.S. tertiary care hospital, data from patients who underwent an ileostomy or colostomy creation from June 1, 2013, to April 30, 2017 were extracted from an institutional database. Patients who received early diet advancement (postoperative days 0 and 1) were compared with traditional diet advancement (postoperative day 2 and later) for demographics, preoperative risk factors, and operative features. The postoperative feeding outcomes included time to first flatus and ostomy output. Mann-Whitney U tests determined bivariate differences in postoperative feeding outcomes between groups. Poisson regression was used to adjust for unequal baseline characteristics. RESULTS Data from 255 patients were included; 204 (80.0%) received early diet advancement, and 51 (20.0%) had traditional diet advancement. Time to first flatus and time to first ostomy output were significantly shorter in the early compared with traditional diet advancement group (median difference of 1 day for both flatus and ostomy output, P < 0.001). Adjusting for baseline group differences (American Society for Anesthesiology Physical Status Classification System, surgical approach, resection and ostomy type) maintained the significant findings for both time to first flatus (β = 1.32, P = 0.01) and time to first ostomy output (β = 1.41, P < 0.001). CONCLUSIONS Early diet advancement is associated with earlier return of flatus and first ostomy output compared with traditional diet advancement after the creation of an ileostomy or colostomy.
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Affiliation(s)
- Sabrina Toledano
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Camden, New Jersey, USA
| | - Joachim Sackey
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Camden, New Jersey, USA
| | - Kate Willcutts
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - J Scott Parrott
- Department of Interdisciplinary Studies, Rutgers University, Camden, New Jersey, USA
| | - Jennifer Tomesko
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Camden, New Jersey, USA
| | - Ahmed M Al-Mazrou
- NewYork-Presbyterian Hospital Columbia University Medical Center, New York, New York, USA
| | - Ravi P Kiran
- NewYork-Presbyterian Hospital Columbia University Medical Center, New York, New York, USA
| | - Rebecca A Brody
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Camden, New Jersey, USA
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3
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Chough I, Zaghiyan K, Ovsepyan G, Fleshner P. Practice Changes in Postoperative Feeding after Elective Colorectal Surgery: From Prospective Randomized Study to Everyday Practice. Am Surg 2018. [DOI: 10.1177/000313481808401028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Early postoperative feeding is the standard of care after colorectal surgery and is associated with improved outcomes. A controlled study performed at our center demonstrated faster bowel function recovery and shorter hospital stay without an increase in postoperative morbidity for a solid versus clear-liquid diet on postoperative day (POD) 1 after colorectal surgery. The present study aims to evaluate the impact of these findings on the practice of diet advancement by board-certified general surgeons (GS) and colorectal surgeons (CRS) at an urban teaching hospital. Patients undergoing elective colorectal surgery were prospectively evaluated. Data were compared with that of a study cohort that underwent elective colorectal surgery reported in 2012. Early postoperative feeding in the more recent cohort statistically increased for all cases on POD 0 and POD 1. Diet advancement over time revealed significant changes in early feeding on POD 0 for patients operated on by CRS (0% vs 83%; P < 0.0001) but not GS (13% vs 13%; P = 1). Patients operated on by either CRS or GS and offered early feeding on POD 1 did not significantly differ between time periods. Despite well-documented evidence of the advantages of early feeding, GS, but not CRS, remain reluctant to administer early diets to patients after colorectal surgery.
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Affiliation(s)
- Ino Chough
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Karen Zaghiyan
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gayane Ovsepyan
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Phillip Fleshner
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Steele SR, Feldman LS. Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc 2017; 31:3412-3436. [DOI: 10.1007/s00464-017-5722-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 12/16/2022]
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5
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Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2017; 60:761-784. [PMID: 28682962 DOI: 10.1097/dcr.0000000000000883] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rattray M, Roberts S, Marshall A, Desbrow B. A systematic review of feeding practices among postoperative patients: is practice in-line with evidenced-based guidelines? J Hum Nutr Diet 2017; 31:151-167. [PMID: 28589624 DOI: 10.1111/jhn.12486] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Early oral feeding after surgery is best practice among adult, noncritically ill patients. Evidenced-based guidelines (EBG) recommend commencing liquid and solid feeding within 24 h of surgery to improve patient (e.g. reduced morbidity) and hospital (e.g. reduced length of stay) outcomes. Whether these EBG are adhered to in usual clinical practice remains unknown. The present study aimed to identify the time to commencement of first oral feed (liquid or solid) and first solid feed among postoperative, noncritically ill, adult patients. METHODS MEDLINE, CINAHL, SCOPUS and Web of Science databases were searched from inception to June 2016 for observational studies reporting liquid and/or solid feeding practices among postoperative patients. Studies reporting a mean/median time to first feed or first solid feed within 24 h of surgery or where ≥75% of patients were feeding by postoperative day one were considered in-line with EBG. RESULTS Of 5826 articles retrieved, 29 studies were included. Only 40% and 22% of studies reported time to first feed and time to first solid feed in-line with EBG, respectively. Clear and free liquids were the first diet types commenced in 86% of studies. When solids were commenced, 44% of studies reported using various therapeutic diet types (e.g. light) prior to the commencement of a regular diet. Patients who underwent gastrointestinal procedures appeared more likely to experience delayed postoperative feeding. CONCLUSIONS Our findings demonstrate a gap between postoperative feeding evidence and its practical application. This information provides a strong rationale for interventions targeting improved nutritional care following surgery.
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Affiliation(s)
- M Rattray
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - S Roberts
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,National Centre of Research Excellence in Nursing (NCREN), Griffith University, Southport, QLD, Australia
| | - A Marshall
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,National Centre of Research Excellence in Nursing (NCREN), Griffith University, Southport, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Southport, QLD, Australia
| | - B Desbrow
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
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Rattray M, Desbrow B, Roberts S. Comparing nutritional requirements, provision and intakes among patients prescribed therapeutic diets in hospital: An observational study. Nutrition 2017; 39-40:50-56. [PMID: 28606570 DOI: 10.1016/j.nut.2017.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Nutrition is an important part of recovery for hospitalized patients. The aim of this study was to assess the nutritional adequacy of meals provided to and consumed by patients prescribed a therapeutic diet. METHODS Patients (N = 110) prescribed a therapeutic diet (texture-modified, low-fiber, oral fluid, or food allergy or intolerance diets) for medical or nutritional reasons were recruited from six wards of a tertiary hospital. Complete (24-h) dietary provisions and intakes were directly observed and analyzed for energy (kJ) and protein (g) content. A chart audit gathered demographic, clinical, and nutrition-related information to calculate each patient's disease-specific estimated energy and protein requirements. Provisions and intake were considered adequate if they met ≥75% of the patient's estimated requirements. RESULTS Mean energy and protein provided to patients (5844 ± 2319 kJ, 53 ± 30 g) were significantly lower than their mean estimated requirements (8786 ± 1641 kJ, 86 ± 18 g). Consequently, mean nutrition intake (4088 ± 2423 kJ, 37 ± 28 g) were significantly lower than estimated requirements. Only 37% (41) of patients were provided with and 18% (20) consumed adequate nutrition to meet their estimated requirements. No therapeutic diet provided adequate food to meet the energy and protein requirements of all recipients. Patients on oral fluid diets had the highest estimated requirements (9497 ± 1455 kJ, 93 ± 16 g) and the lowest nutrient provision (3497 ± 1388 kJ, 25 ± 19 g) and intake (2156 ± 1394 kJ, 14 ± 14 g). CONCLUSION Hospitalized patients prescribed therapeutic diets (particularly fluid-only diets) are at risk for malnutrition. Further research is required to determine the most effective strategies to improve nutritional provision and intake among patients prescribed therapeutic diets.
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Affiliation(s)
- Megan Rattray
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD, Australia.
| | - Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD, Australia
| | - Shelley Roberts
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD, Australia; NHMRC Centre of Research Excellence in Nursing, Griffith University, Gold Coast Campus, Australia
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Lau C, Phillips E. Does Diet Make a Difference Following Colon Surgery? Adv Surg 2015; 49:95-105. [PMID: 26299492 DOI: 10.1016/j.yasu.2015.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Cheryl Lau
- Jurong Health Services, 38 Dakota Crescent, Suite 07-09, Singapore 399938, Singapore
| | - Edward Phillips
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 8215NT, Los Angeles, CA 90048, USA.
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Early use of low residue diet is superior to clear liquid diet after elective colorectal surgery: a randomized controlled trial. Ann Surg 2014; 260:641-7; discussion 647-9. [PMID: 25203881 DOI: 10.1097/sla.0000000000000929] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compare the feasibility and patient tolerance to either a clear fluid (CF) or low residue diet (LRD) started on postoperative day (POD) 1 after elective colorectal surgery. BACKGROUND Diet advancement after surgery traditionally starts gradually with liquids, on the basis of fears that early solid intake may increase nausea, vomiting, and overall complications. A randomized controlled trial comparing LRD and CF on POD 1 was performed. METHODS 111 elective colorectal surgery patients were randomized to CF (n = 57) or LRD (n = 54). The primary end point was vomiting on POD 2. Secondary endpoints included nausea score, days to flatus, length of hospital stay (LOS), and postoperative morbidity. RESULTS Patient characteristics, surgical technique, intraoperative characteristics, and postoperative opioid use were similar between study arms. CF versus LRD results were as follows: POD2 vomiting (28% vs 14%; P = 0.09), and significant increase in mean nausea score (4.7 vs 3.5; P = 0.01), days to flatus (4.8 vs 3.7 days; P = 0.04), and LOS (7.0 vs 5.0 days; P = 0.01). LOS remained significantly shorter even after adjusting for significant covariates (laparoscopic technique, surgical site, postoperative comorbidity, stoma, and nasogastric tube) with LRD patients having an adjusted 1.4-day decrease in LOS (P < 0.01). There was no significant difference in postoperative morbidity between study arms. Multivariate analysis of all secondary endpoints confirmed an overall significant improvement in outcomes for LRD vs CF (P < 0.01). CONCLUSIONS LRD, rather than CF, on POD1 after colorectal surgery is associated with less nausea, faster return of bowel function, and a shorter hospital stay without increasing postoperative morbidity.
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Mahmoodzadeh H, Shoar S, Sirati F, Khorgami Z. Early initiation of oral feeding following upper gastrointestinal tumor surgery: a randomized controlled trial. Surg Today 2014; 45:203-8. [PMID: 24875466 DOI: 10.1007/s00595-014-0937-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/11/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Despite increasing trends toward the early initiation of oral feeding after gastrointestinal (GI) surgeries, current evidence has not been convincing. The present randomized clinical trial aimed to compare the clinical outcomes of early oral feeding (EOF) with late oral feeding (LOF) following surgery for upper GI tumors. METHODS One hundred and nine consecutive patients with esophageal or gastric tumors undergoing surgical resection in two hospitals in Tehran, Iran, were enrolled in this prospective randomized controlled trial, and were randomly assigned to a group starting EOF on the first postoperative day and another group that remained nil by mouth until the return of bowel sounds (LOF group). The clinical and surgical outcomes were compared between the two groups. RESULTS The clinical outcomes were significantly better in the patients in the EOF group (p < 0.05). Repeated nil per os (14.8 vs. 30.9 %) and re-hospitalization (1.8 vs. 7.3 %) were more common in LOF group (p < 0.0001). Additionally, gas passage, nasogastric tube (NGT) discharge, a decrease in intravenous serum to less than 1000 ml per day, the time to start a soft diet and hospital discharge following surgery occurred significantly earlier in the EOF group than in the LOF group (p < 0.0001). CONCLUSION Early oral feeding after the surgical resection of esophageal and gastric tumors is safe, and is associated with favorable early in-hospital outcomes and a sooner return to physiological GI function and hospital discharge.
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Affiliation(s)
- Habibollah Mahmoodzadeh
- Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Pragatheeswarane M, Muthukumarassamy R, Kadambari D, Kate V. Early oral feeding vs. traditional feeding in patients undergoing elective open bowel surgery-a randomized controlled trial. J Gastrointest Surg 2014; 18:1017-23. [PMID: 24627256 DOI: 10.1007/s11605-014-2489-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 02/25/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This prospective randomized controlled trial was conducted to compare the safety, tolerability and outcome of early oral feeding vs. traditional feeding in patients undergoing elective open bowel surgery. METHODS A total of 120 consecutive patients who underwent elective open bowel surgeries were randomized into either early feeding (n = 60) or traditional feeding group (n = 60). Patients in the early feeding group were started on oral fluids on post-operative day 1, while those in the traditional feeding group were started orals after the resolution of ileus. Patient characteristics, surgical procedures, co-morbidity, first flatus, first defecation, time of starting solid diet, complications and length of hospitalization were assessed between the two groups. RESULTS The two groups were similar in demographic and baseline data. The number of days to first flatus (p < 0.0001), first defecation (p < 0.0001), length of post-operative stay (p = 0.011) and time of starting solid diet (p < 0.0001) were significantly earlier in the early feeding group. Anastomotic leak, wound infection, fever, vomiting, abdominal distention and other complications were similar. Multivariate analysis showed that patients in the early oral feeding group were discharged 3.4 days earlier (p = 0.037). CONCLUSION In patients undergoing elective open bowel surgeries, early post-operative feeding is safe, is well tolerated and reduces the length of hospitalization.
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Affiliation(s)
- M Pragatheeswarane
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
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Kim HO, Lee SR, Choi WJ, Kim H. Early oral feeding following laparoscopic colorectal cancer surgery. ANZ J Surg 2014; 84:539-44. [DOI: 10.1111/ans.12550] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 01/30/2023]
Affiliation(s)
- Hyung Ook Kim
- Department of Surgery; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Sung Ryol Lee
- Department of Surgery; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Won Joon Choi
- Department of Anesthesiology and Pain Medicine; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Hungdai Kim
- Department of Surgery; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
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Zaid HB, Kaffenberger SD, Chang SS. Improvements in safety and recovery following cystectomy: reassessing the role of pre-operative bowel preparation and interventions to speed return of post-operative bowel function. Curr Urol Rep 2013; 14:78-83. [PMID: 23397271 DOI: 10.1007/s11934-012-0300-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
For radical cystectomy, historical practice trends have favored the use of preoperative bowel preparations to reduce complications, including surgical site infections, ileus, and anastomotic leaks. However, emerging data has questioned this practice. Postoperative cystectomy care also remains in flux, as new pharmacologic agents that may potentiate earlier return of bowel function are studied. We review the current literature with regards to preoperative and postoperative cystectomy bowel management.
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Affiliation(s)
- Harras B Zaid
- Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN 37232-2765, USA.
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