Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, People's Republic of China.
Langenbecks Arch Surg. 2022 Feb;407(1):113-122. doi: 10.1007/s00423-021-02330-6. Epub 2021 Sep 21.
Enhanced recovery after surgery (ERAS) program has become the main trend in gastrointestinal surgery. This study aims to investigate factors influencing the decision-making of nasogastric tube (NGT) placement and its safety and efficacy after gastrectomy.
We analyzed our prospectively maintained database including 287 patients who underwent elective gastrectomy in our department from January 1 to December 31, 2017. All cases were divided into two groups, namely, the no-NGT group and the NGT group. Logistic regression was used to analyze factors that affected the decision of NGT placement, and propensity score matching (PSM) was later applied to balance those factors for the analysis of safety outcomes between groups.
Multivariate analysis showed resection range (p = 0.004, proximal gastrectomy: OR = 4.555, 95%CI = 1.392-14.905, p = 0.016; total gastrectomy: OR = 1.990, 95%CI = 1.205-3.287, p = 0.009) was the only independent risk factor of NGT placement. NGT was omitted in the majority (58.8%) of distal gastrectomy but only in 42.5% and 25% in total and proximal gastrectomy. After PSM, we found no significant differences between patients with or without NGT in postoperative hospital stay, time to first flatus and defecation, time to fluid and semi-fluid diet, rate of reinsertion, or hospitalization expenditure (p > 0.05, respectively). The incidence of postoperative complications in the two groups were 21.7% and 23.5%, respectively (p = 0.753), and the incidence of major complications was 7.0% and 9.6% (p = 0.472).
The decision-making of NGT placement is mainly influenced by the resection range. Omitting NGT is a safe approach in all types of gastrectomy but was not able to enhance the recovery in our practice.
术后加速康复（ERAS）方案已成为胃肠外科的主要趋势。本研究旨在探讨影响胃切除术后留置鼻胃管（NGT）决策的因素及其安全性和有效性。
我们分析了 2017 年 1 月 1 日至 12 月 31 日在我科行择期胃切除术的 287 例患者的前瞻性数据库。所有患者均分为无 NGT 组和 NGT 组。采用 Logistic 回归分析影响 NGT 置管决策的因素，然后应用倾向评分匹配（PSM）平衡组间的这些因素，以分析组间安全性结局。
多因素分析显示，切除范围（p=0.004，近端胃切除术：OR=4.555，95%CI=1.392-14.905，p=0.016；全胃切除术：OR=1.990，95%CI=1.205-3.287，p=0.009）是 NGT 置管的唯一独立危险因素。大多数（58.8%）远端胃切除术后省略了 NGT，但在全胃和近端胃切除术中仅分别省略了 42.5%和 25%。PSM 后，我们发现有无 NGT 的患者在术后住院时间、首次排气和排便时间、液体和半液体饮食时间、再插入率和住院费用方面均无显著差异（p>0.05，分别）。两组术后并发症发生率分别为 21.7%和 23.5%（p=0.753），主要并发症发生率分别为 7.0%和 9.6%（p=0.472）。
NGT 置管的决策主要受切除范围的影响。在所有类型的胃切除术中，不放置 NGT 是一种安全的方法，但在我们的实践中并不能促进恢复。
