A comparison of early and late feeding after emergency gastrointestinal surgery

Abstract

The adopt of early feeding after emergency gastrointestinal (GI) surgery is still debate despite a recommendation of early feeding by the guidelines of the Society of Parenteral and Enteral Nutrition. The aim of this study was to compare and assess the feasibility of early feeding in patients that have undergone emergency GI surgery. This study was retrospective review of 112 patients that underwent emergency GI surgery from March 2008 to December 2011. Inclusion criteria were followings; stayed in the ICU less than 3 days and undergone bowel resection and/or anastomosis. Exclusion criteria were followings; stayed in the ICU more than 3 days (n=19), severe shock requiring massive resuscitation (n=4), short bowel syndrome (n=3), sustained intestinal ischemia (n=1) and perforation (n=1). So, total 84 patients were analyzed. They were divided into an early (E; n=44) or a late (L; n=40) group according to time of the commencement of feeding. Early feeding was defined when oral or enteral feeding was started within 48 hours after surgery with liquid or soft diet or enteral formula. The most common cause of operation was bowel perforation, and the small bowel was the most common involved site. There were no significant intergroup differences between causes, sites, methods of operation, overall complications and other outcomes. However, the length of intensive care unit stay (1 vs 2 days, p=0.038) and the length of hospital stay after operation was significantly longer (9 vs 12 days, p=0.012), and pulmonary complications were also significantly more common in group L (13.6 vs. 47.5%, p=0.001). In E group, one patient underwent re-operation to treat an anastomotic disruption. There was no post-operative mortality in this study. After emergency GI surgery, early feeding may be possible in selected patients without severe inducing complications.