Mvoula Lord, Irizarry Evelyn
Surgery, Lincoln Medical and Mental Health Center, Bronx, USA.
Colorectal Surgery, Lincoln Medical and Mental Health Center, Bronx, USA.
Cureus. 2023 Aug 4;15(8):e42943. doi: 10.7759/cureus.42943. eCollection 2023 Aug.
Although practice guidelines recommend resuming oral feeding immediately after gastrointestinal surgery, many practitioners remain reluctant to order early oral feeding (EOF). Therefore, this review aimed to clarify the tolerance to and postoperative outcomes with EOF among patients undergoing bowel surgery. A systematic review of the literature published between January 1990 and July 2022 with the time of oral intake (early or delayed until resolution of ileus) as the exposure variable was conducted using PubMed and Scopus databases. Outcomes of interest included tolerance to EOF and postoperative adverse effects or complications. After screening 1,667 research articles, 18 randomized control trials, six prospective case series, and four cohort studies met our inclusion criteria, collectively representing data from 2,647 patients in eleven countries. These studies indicate that while most patients tolerate EOF, 5-25% may not tolerate EOF until the fourth postoperative day (POD). Moreover, EOF, at best, has no advantage over delayed feeding in terms of vomiting, nausea, nasogastric tube requirement, or other postoperative complications. In addition, early return of bowel function, lower risk of diarrhea, and lower pain score with EOF are inconsistently reported, and shorter hospitalization with EOF may be limited to those who tolerate oral feeding on POD 0 or 1. Nevertheless, shorter hospitalization with EOF could reduce the cost of hospitalization. A substantial number of patients may not be able to tolerate oral feeding after bowel surgery until POD 4, and in patients who tolerate EOF, the only clear benefit is a shorter length of hospitalization.
尽管实践指南建议胃肠道手术后应立即恢复经口进食，但许多从业者仍不愿安排早期经口进食（EOF）。因此，本综述旨在阐明肠道手术患者对早期经口进食的耐受性及术后结局。使用PubMed和Scopus数据库对1990年1月至2022年7月发表的文献进行系统综述，以经口摄入时间（早期或延迟至肠梗阻缓解）作为暴露变量。感兴趣的结局包括对早期经口进食的耐受性以及术后不良反应或并发症。在筛选了1667篇研究文章后，18项随机对照试验、6项前瞻性病例系列研究和4项队列研究符合我们的纳入标准，共代表了11个国家2647例患者的数据。这些研究表明，虽然大多数患者能耐受早期经口进食，但5%-25%的患者可能直到术后第4天（POD）才耐受。此外，在呕吐、恶心、鼻胃管需求或其他术后并发症方面，早期经口进食至多并不比延迟进食更具优势。另外，关于早期经口进食能使肠功能更早恢复、腹泻风险降低以及疼痛评分降低的报道并不一致，而早期经口进食能缩短住院时间可能仅限于那些在术后第零天或第一天就能耐受经口进食的患者。尽管如此，早期经口进食缩短住院时间可降低住院费用。相当多的患者在肠道手术后直到术后第4天才能够耐受经口进食，而对于能耐受早期经口进食的患者，唯一明确的益处是住院时间缩短。
