Hong Pu1,2, Philippa T Heighes1, Fiona Simpson1,3, Yaoli Wang1,4, Zeping Liang1,4, Paul Wischmeyer5, Thomas J Hugh6, Gordon S Doig7. 1. Northern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia. 2. Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China. 3. Nutrition Services, Royal North Shore Hospital, Sydney, Australia. 4. Department of Critical Care Medicine, Daping Hospital, Chongqing, People's Republic of China. 5. Department of Anesthesiology and Surgery, Duke University, Durham, NC, USA. 6. Upper GI Surgical Department, Royal North Shore Hospital and the University of Sydney, Sydney, Australia. 7. Northern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia. Gordon.Doig@EvidenceBased.net.
Abstract
BACKGROUND: Although current guidelines make consensus recommendations for the early resumption of oral intake after surgery, a recent comprehensive meta-analysis failed to identify any patient-centered benefits. We hypothesized this finding was attributable to pooling studies providing effective protein-containing diets with ineffective non-protein liquid diets. Therefore, the aim of this paper was to investigate the safety and efficacy of early oral protein-containing diets versus later (traditional) feeding after elective lower gastrointestinal tract surgery in adults. METHODS: PubMed, Embase, and the China National Knowledge Infrastructure databases were searched from inception until 1 August 2019. Reference lists of retrieved studies were hand searched to identify randomized clinical trials reporting mortality. No language restrictions were applied. Study selection, risk of bias appraisal and data abstraction were undertaken independently by two authors. Disagreements were settled by obtaining an opinion of a third author. Majority decisions prevailed. After assessment of underlying assumptions, a fixed-effects method was used for analysis. The primary outcome was mortality. Secondary outcomes included surgical site infections, postoperative nausea and vomiting, serious postoperative complications and other key measures of safety and efficacy. RESULTS: Eight randomized clinical trials recruiting 657 patients were included. Compared with later (traditional) feeding, commencing an early oral protein-containing diet resulted in a statistically significant reduction in mortality (odds ratio [OR] 0.31, P = 0.02, I2 = 0%). An early oral protein-containing diet also significantly reduced surgical site infections (OR 0.39, P = 0.002, I2 = 32%), postoperative nausea and vomiting (OR 0.62, P = 0.04, I2 = 37%), serious postoperative complications (OR 0.60, P = 0.01, I2 = 25%), and significantly improved other major outcomes. No harms attributable to an early oral protein-containing diet were identified. CONCLUSIONS: The results of this systematic review can be used to upgrade current guideline statements to a grade A recommendation supporting an oral protein-containing diet commenced before the end of postoperative day 1 after elective lower gastrointestinal surgery in adults.
BACKGROUND: Although current guidelines make consensus recommendations for the early resumption of oral intake after surgery, a recent comprehensive meta-analysis failed to identify any patient-centered benefits. We hypothesized this finding was attributable to pooling studies providing effective protein-containing diets with ineffective non-protein liquid diets. Therefore, the aim of this paper was to investigate the safety and efficacy of early oral protein-containing diets versus later (traditional) feeding after elective lower gastrointestinal tract surgery in adults. METHODS: PubMed, Embase, and the China National Knowledge Infrastructure databases were searched from inception until 1 August 2019. Reference lists of retrieved studies were hand searched to identify randomized clinical trials reporting mortality. No language restrictions were applied. Study selection, risk of bias appraisal and data abstraction were undertaken independently by two authors. Disagreements were settled by obtaining an opinion of a third author. Majority decisions prevailed. After assessment of underlying assumptions, a fixed-effects method was used for analysis. The primary outcome was mortality. Secondary outcomes included surgical site infections, postoperative nausea and vomiting, serious postoperative complications and other key measures of safety and efficacy. RESULTS: Eight randomized clinical trials recruiting 657 patients were included. Compared with later (traditional) feeding, commencing an early oral protein-containing diet resulted in a statistically significant reduction in mortality (odds ratio [OR] 0.31, P = 0.02, I2 = 0%). An early oral protein-containing diet also significantly reduced surgical site infections (OR 0.39, P = 0.002, I2 = 32%), postoperative nausea and vomiting (OR 0.62, P = 0.04, I2 = 37%), serious postoperative complications (OR 0.60, P = 0.01, I2 = 25%), and significantly improved other major outcomes. No harms attributable to an early oral protein-containing diet were identified. CONCLUSIONS: The results of this systematic review can be used to upgrade current guideline statements to a grade A recommendation supporting an oral protein-containing diet commenced before the end of postoperative day 1 after elective lower gastrointestinal surgery in adults.
Entities:
Keywords:
Elective surgery; Meta-analysis; Mortality; Postoperative nutrition; Protein
Authors: Jane E Carré; Jean-Christophe Orban; Lorenza Re; Karen Felsmann; Wiebke Iffert; Michael Bauer; Hagir B Suliman; Claude A Piantadosi; Terry M Mayhew; Patrick Breen; Martin Stotz; Mervyn Singer Journal: Am J Respir Crit Care Med Date: 2010-06-10 Impact factor: 21.405