Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne 1011, Switzerland.
Nutrients. 2017 Dec 8;9(12):1336. doi: 10.3390/nu9121336.
Enhanced Recovery After Surgery (ERAS) protocols advocate early postoperative resumption of normal diet to decrease surgical stress and prevent excessive catabolism. The aim of the present study was to identify reasons for delayed tolerance of normal postoperative diet. This was a retrospective analysis including all consecutive colorectal surgical procedures since May 2011 until May 2017. Data was prospectively recorded by an institutional data manager in a dedicated database. Uni- and multivariate risk factors associated with delayed diet (beyond POD 2) were identified by multiple logistic regression among demographic, surgery- and modifiable pre- and intraoperative ERAS-related items. In a second step, univariate analysis was performed to compare surgical outcomes for patients with early vs. delayed oral intake. The study cohort consisted of 1301 consecutive colorectal ERAS patients. Herein, 691 patients (53%) were able to resume normal diet within two days of surgery according to ERAS protocol, while in 610 patients (47%), a delay in tolerance of normal diet was observed. Male gender was independently correlated to early tolerance (Odds Ratio (OR) 0.66; 95% Confidence Interval (CI) 0.46-0.84, = 0.002), while ASA score ≥ 3 (OR 1.60; 95% CI 1.12-2.28, = 0.010), abdominal drains (OR 1.80; 95% CI 1.10-2.49, = 0.020), right colectomy (OR 1.64; 95% CI 1.08-2.49, = 0.020) and Hartmann reversal (OR 2.61; 95% CI 1.32-5.18, = 0.006) constituted risk factors for delayed tolerance of normal diet. Patients with delayed resumption of normal diet experienced more overall (Clavien grade I-V) (47% vs. 21%, < 0.001) and major (Clavien grade IIIb-V) (11% vs. 4%, < 0.001) complications and had a longer length of stay (9 ± 5 vs. 5 ± 4 days, < 0.001). Over half of patients could not tolerate early enteral realimentation and were at higher risk for postoperative complications. Prophylactic drain placement was the only independent modifiable risk factor for delayed oral intake.
术后加速康复（ERAS）方案提倡术后早期恢复正常饮食，以减轻手术应激和防止过度分解代谢。本研究旨在确定延迟耐受正常术后饮食的原因。这是一项回顾性分析，纳入了 2011 年 5 月至 2017 年 5 月期间所有连续的结直肠外科手术。通过机构数据管理员在专用数据库中前瞻性记录数据。通过多元逻辑回归，确定与延迟饮食（术后第 2 天）相关的人口统计学、手术和可修改的术前和术中 ERAS 相关因素的单一和多变量危险因素。在第二步中，通过单变量分析比较早期和延迟口服摄入的手术结果。研究队列包括 1301 例连续接受 ERAS 的结直肠患者。其中，根据 ERAS 方案，691 例（53%）患者在术后两天内能够恢复正常饮食，而在 610 例（47%）患者中，观察到正常饮食的耐受性延迟。男性是早期耐受的独立相关因素（优势比（OR）0.66；95%置信区间（CI）0.46-0.84， = 0.002），而美国麻醉师协会（ASA）评分≥3（OR 1.60；95%CI 1.12-2.28， = 0.010）、腹部引流（OR 1.80；95%CI 1.10-2.49， = 0.020）、右半结肠切除术（OR 1.64；95%CI 1.08-2.49， = 0.020）和 Hartmann 反转术（OR 2.61；95%CI 1.32-5.18， = 0.006）是正常饮食耐受性延迟的危险因素。延迟恢复正常饮食的患者经历了更多的总体（Clavien 分级 I-V）（47%比 21%，<0.001）和主要（Clavien 分级 IIIb-V）（11%比 4%，<0.001）并发症，并且住院时间更长（9 ± 5 比 5 ± 4 天，<0.001）。超过一半的患者不能早期接受肠内营养支持，并且术后并发症的风险更高。预防性引流放置是延迟口服摄入的唯一独立可修改危险因素。
