General Surgical Division, Department of Surgery, Cosme Argerich Hospital, Pi y Margall 750, C1155AHD, Buenos Aires, Argentina.
World J Surg. 2013 Oct;37(10):2293-9. doi: 10.1007/s00268-013-2143-1.
Early oral feeding (EOF) has been demonstrated to be safe and beneficial after abdominal elective surgery. The aim of this randomized controlled trial is to assess the safety and benefits of EOF compared to traditional postoperative care (TPC) after abdominal emergency surgery.
Patients assigned to the EOF group commenced a soft diet within 24 h after surgery. In the TPC group, a liquid diet was commenced upon passage of flatus or stool and then advanced to soft food. The primary endpoint was the complication rate. Secondary endpoints were severity of complications, mortality, gastrointestinal leaks, surgical-site infection, reoperation, diet intolerance, time to first flatus and stool, amount of food intake, postoperative discomfort, hospital stay, weight loss at the 15th postoperative day and incisional hernias.
A total of 295 patients assigned to EOF (n = 148) or TPC (n = 147) were analyzed. No significant differences were seen in the complications rates (EOF 45.3 % vs. TPC 37.4 %; p = 0.1). There was a significantly higher rate of vomiting with EOF (EOF 13.5 % vs. TPC 6.1 %; p = 0.03), with no differences in nasogastric tube reinsertion. EOF patients' food intake was proportionally lower for the first three meals than that of TPC patients (p < 0.01). Postoperative discomfort survey revealed more hunger in the TPC group (p < 0.01). There were no differences in postoperative ileus or length of hospital stay.
EOF was safe after abdominal emergency surgery. EOF was associated with more vomiting (treated easily and without patient discomfort) and less hunger than with TPC. No other EOF-related benefits could be demonstrated during this trial.
择期腹部手术后早期口服喂养（EOF）已被证明是安全且有益的。本随机对照试验的目的是评估 EOF 与腹部急诊手术后传统术后护理（TPC）相比的安全性和益处。
EOF 组患者在手术后 24 小时内开始进软食。TPC 组患者在排气或排便后开始进流食，然后逐渐过渡到软食。主要终点是并发症发生率。次要终点是并发症严重程度、死亡率、胃肠道漏、手术部位感染、再次手术、饮食不耐受、首次排气和排便时间、食物摄入量、术后不适、住院时间、术后第 15 天体重减轻和切口疝。
共分析了 295 例分配至 EOF（n = 148）或 TPC（n = 147）的患者。两组并发症发生率无显著差异（EOF 45.3% vs. TPC 37.4%；p = 0.1）。EOF 组呕吐发生率明显更高（EOF 13.5% vs. TPC 6.1%；p = 0.03），但需要重新插入鼻胃管的比例无差异。EOF 组患者前 3 餐的食物摄入量明显低于 TPC 组（p < 0.01）。术后不适调查显示 TPC 组患者更饥饿（p < 0.01）。两组术后肠梗阻或住院时间无差异。
EOF 用于腹部急诊手术后是安全的。EOF 与 TPC 相比，呕吐发生率更高（易于治疗且不会引起患者不适），饥饿感更低。在本试验中，未发现 EOF 相关的其他益处。
