Document Detail


Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial.
MedLine Citation:
PMID:  18438106     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aim of this trial was to investigate whether a routine of allowing normal food at will increases morbidity after major upper gastrointestinal (GI) surgery. SUMMARY BACKGROUND DATA: Nil-by-mouth with enteral tube feeding is widely practiced for several days after major upper GI surgery. After other abdominal operations, normal food at will has been shown to be safe and to improve gut function. METHODS: Patients were randomly assigned to a routine of nil-by-mouth and enteral tube feeding by needle-catheter jejunostomy (ETF group) or normal food at will from the first day after major upper GI surgery. Primary end point was rate of major complications and death. Secondary outcomes were minor complications and adverse events, bowel function, and length of stay. All patients were invited to a follow-up at 8 weeks after discharge from the hospital. RESULTS: Four hundred fifty-three patients who underwent major open upper GI surgery in 5 centers were enrolled between 2001 and 2006. Four hundred forty-seven patients were correctly randomized. Of 227 patients 76 (33.5%) had major complications in the ETF group compared with 62 (28.2%) of 220 patients allowed normal food at will (P = 0.26, 95% CI for the difference in rate from -3.3 to 13.9). In the ETF group, 36 (15.9%) patients were reoperated compared with 29 (13.2%) in the group allowed normal food at will (P = 0.50) and 30-day mortality was 10 (4.4%) of 227 and 11 (5.0%) of 220 patients, respectively (P = 0.83). Time to resumed bowel function was significantly in favor of allowing normal food at will (P = 0.01), as were the total number of major complications, length of stay, and rate of postdischarge complications. CONCLUSIONS: Allowing patients to eat normal food at will from the first day after major upper GI surgery does not increase morbidity compared with traditional care with nil-by-mouth and enteral feeding.
Authors:
Kristoffer Lassen; Jørn Kjaeve; Torunn Fetveit; Gerd Tranø; Helgi Kjartan Sigurdsson; Arild Horn; Arthur Revhaug
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of surgery     Volume:  247     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-28     Completed Date:  2008-06-03     Revised Date:  2009-01-06    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  721-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Gastrointestinal Surgery, University Hospital Northern Norway, Tromsø, Norway. lassen@unn.no
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MeSH Terms
Descriptor/Qualifier:
Aged
Digestive System Surgical Procedures*
Eating*
Enteral Nutrition*
Female
Follow-Up Studies
Food*
Humans
Length of Stay
Male
Middle Aged
Postoperative Care*
Postoperative Complications*
Recovery of Function
Treatment Outcome
Volition
Comments/Corrections
Comment In:
Ann Surg. 2008 May;247(5):730-1   [PMID:  18438107 ]
Evid Based Nurs. 2009 Jan;12(1):21   [PMID:  19103839 ]
Ann Surg. 2008 Dec;248(6):1108-9; author reply 1109-10   [PMID:  19092361 ]
Nat Clin Pract Gastroenterol Hepatol. 2008 Dec;5(12):660-1   [PMID:  18941433 ]

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