Early-Feeding Intolerance Associated With Complications After Colorectal Surgery

Intolerance in early oral feeding is closely associated with postoperative complications after colorectal surgery, according to study results published in Colorectal Disease.

In this study, researchers evaluated 3034 patients in the Francophone Group for Enhanced Recovery after Surgery (GRACE) database who underwent elective colorectal surgery with a perioperative enhanced recovery program between January 2014 and May 2018. All patients were encouraged to eat within the first 24 hours after surgery and separated into 2 groups based on whether early feeding was well tolerated (WT) or poorly tolerated (PT). PT feeding was characterized by loss of appetite, inability to eat, or nausea, vomiting, or gastric upset after eating.

The primary outcome measure was overall postoperative medical and surgical complications. Secondary outcome measures were unplanned reoperations, rate of early mobilization within 24 hours, and length of postoperative hospital stay.

Results revealed that early feeding was WT in 2614 patients and PT in 420 patients. The PT group experienced significantly more postoperative complications than the WT group (52.1% vs 17.0% respectively, P =.001). When comparing postoperative complications between the PT and WT groups, the rate of unplanned reoperations was 10.5% vs 3.7% respectively (P =.001), early mobilization rate was 87.6% vs 91.5% respectively (P =.01), and median hospital stay was 8 [IQR 6-13] days vs 5 [IQR 3-7] days respectively (P =.001).

Multivariate analyses confirmed that PT early feeding (odds ratio [OR] 4.47; 95% CI, 3.49-5.72; P <.001) was the main and dominant independent factor of postoperative complications. PT early feeding was also closely associated with more unplanned operations (OR 2.74; 95% CI, 1.80-4.16; P <.001), delayed mobilization (OR 1.88; 95% CI, 1.33-2.65; P <.001), and longer hospital stay (regression coefficient 4.59; 95% CI, 3.04-6.14; P <.001). Additionally, sensitivity analysis demonstrated that PT early feeding was significantly associated with postoperative complications (OR 4.13; 95% CI, 3.37-5.32)

This study had 3 limitations. First, it was a retrospective analysis of a prospective database, and groups were not similar regarding some pre and intraoperative factors such as gender, open procedures, duration of surgery, rectal surgery, and prevention of nausea and vomiting. Second, GRACE database is not a comprehensive register, and less than 20% of patients treated at participating centers were included in the database. Third, researchers acknowledged that larger studies are needed in the future to confirm findings.

The study researchers concluded that there is a close association between intolerance to early oral feeding after colorectal surgery and postoperative complications and that patients should be closely monitored and not discharged until complications have been ruled out.

Reference

Slim K, Reymond T, Joris J, Paul S, Pereira B, Cotte E. Intolerance to early oral feeding in enhanced recovery after colorectal surgery: an early red flag? [published online July 22, 2019]. Colorectal Dis. doi: 10.1111/codi.14785