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A Randomized Controlled Trial of Early Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intra-Abdominal Surgery
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PERIOPERATNE CARE
PERIOPERATIVE CARE A Randomized Controlled Trial of Early Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intra-AbdominalSurgery M. L.PEARL,F.A. VALEA,M.FISCHER,L. MAHLERAND E. CHALAS, Division of Gynecologic Oncology, Departments of Obstetrics, Gynecology and Reproductive Medicine, and Surgery, State University of New York at Stony Brook, Stony Brook, New York Obst. Gynec., 92 94-97, 1998 Objective: To evaluate the safety and efficacy of early oral feeding aRer intra-abdominal surgery in gynecologic oncology patients. Methods: During a 1-year period, 200 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early compared with traditional oral postoperative feeding. Patients allocated to early postoperative oral feeding began a clear liquid diet on the first postoperative day and then advanced to a regular diet as tolerated. Patients allocated to traditional postoperative oral feeding received nothing by mouth UntiI return of bowel function (defined as the passage of flatus in the absence of vomiting or abdominal distention), then began a clear liquid diet, and advanced to a regular diet as tolerated. Results: Age, case distribution, surgery length, blood loss, and first passage of flatus were similar in the early and traditional feeding groups. Significantly more patients in the early group developed nausea. Despite this, the incidence of vomiting, abdominal distention, incidence and duration of nasogastric tube use, and percentage of patients who tolerated clear liquid and regular diets on the first attempt were comparable in both groups. Time to development of bowel sounds, time to initiation of clear liquid and regular diets, and hospital stay were significantly longer in the traditional group. Major complications (eg, pneumonia, ateiectasis, and wound complications) and febrile morbidity occurred equaliy in both groups. There were no known anastamotic complications or aspirations in either group. Postoperative changes in hematologic indices and electrolytes were comparable in both groups. Conclusion: Early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery is safe and well tolerated.
Editorial Comment: Not too many years ago, use of a nasogastric tube until active bowel munds were present and the patient was passing flatus was the usual standard of care after mqjor intra-abdominalprocedures. The pendulum certainly has swung toward earlier resumption of oral feeding, even in cases of bowel anastomosis. This randomized trial demonstrated that patients who were started on dietary intake sooner had no increase in complications and were able to leave the hospital earlier. There was more nausea reported in the early feeding group but only 3%of patients required insertion of a nasogastric tube. Joseph A. Smith, Jr., M.D. Mechanical Bowel Preparation for Elective Colorectal Surgery: A Prospective, Randomized, Surgeon-Blinded Trial Comparing Sodium Phosphate and Polyethylene Glycol-Based Oral Lavage Solutions L. OLNEIRA, S. D. WEXNER,N. DANIEL, D. D E W T A E. , G. WEISS,J. J. NOGUERAS AND M. BERNSTEIN, Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida Dis. Colon Rectum, 40:585-591,1997 AIM:The aim of this study was to compare the cleansing ability, patient compliance, and safety of two oral solutions for elective colorectal surgery. METHODS: All eligible patients were prospectively randomized to receive either 4 1 of standard polyethylene glycol (PEG) solution o r 90 ml of sodium phosphate (Nap) as mechanical bowel preparation for colorectal surgery. A detailed questionnaire was used to assess patient compliance. In addition, the surgeons, blinded to the preparation, intraoperatively evaluated its quality. Postoperative septic complications were also assessed. The calcium serum level was monitored before and after bowel preparation. Statistical analysis was performed using the Wilcoxon’s rank-sum test and Fisher’s exact test. RESULTS: Two hundred patients, well matched for age, gender, and diagnosis, were prospectively randomized to receive either PEG or NaF’ solutions for elective colorectal surgery. All patients completed all phases of the trial. There was a significant decrease in serum calcium levels aRer administration of both NaP (mean, 9.3-8.8 mg/dl) and PEG (9.2-8.9 mg/dl), respectively (P <0.0001), with no clinical sequelae. However, patient tolerance to NaP was superior to P E G less trouble drinking the preparation (17 vs. 32 percent; P <0.0002), less abdominal pain (12 vs. 22 percent; P = 0.004),less bloating (7 VS. 28 percent), and less fatigue (8 vs. 17 percent), respectively. Additionally, 65 percent of patients who received the NaP preparation stated they would repeat this preparation again compared with only 25 percent for the PEG group (P <0.0001). Ninety-five percent of patients who received the NaP solution tolerated 100 percent of the solution compared with only 37 percent of the PEG group (P <0.0001). For quality of cleansing, surgeons scored NaP as “excellent”or “good”in 87 compared with 76 percent after PEG (P= not significant). Rates of septic and anastomotic complications were 1 percent and 1 percent for NaP
PERIOPERATNE CARE
PERIOPERATIVE CARE A Randomized Controlled Trial of Early Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intra-AbdominalSurgery M. L.PEARL,F.A. VALEA,M.FISCHER,L. MAHLERAND E. CHALAS, Division of Gynecologic Oncology, Departments of Obstetrics, Gynecology and Reproductive Medicine, and Surgery, State University of New York at Stony Brook, Stony Brook, New York Obst. Gynec., 92 94-97, 1998 Objective: To evaluate the safety and efficacy of early oral feeding aRer intra-abdominal surgery in gynecologic oncology patients. Methods: During a 1-year period, 200 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early compared with traditional oral postoperative feeding. Patients allocated to early postoperative oral feeding began a clear liquid diet on the first postoperative day and then advanced to a regular diet as tolerated. Patients allocated to traditional postoperative oral feeding received nothing by mouth UntiI return of bowel function (defined as the passage of flatus in the absence of vomiting or abdominal distention), then began a clear liquid diet, and advanced to a regular diet as tolerated. Results: Age, case distribution, surgery length, blood loss, and first passage of flatus were similar in the early and traditional feeding groups. Significantly more patients in the early group developed nausea. Despite this, the incidence of vomiting, abdominal distention, incidence and duration of nasogastric tube use, and percentage of patients who tolerated clear liquid and regular diets on the first attempt were comparable in both groups. Time to development of bowel sounds, time to initiation of clear liquid and regular diets, and hospital stay were significantly longer in the traditional group. Major complications (eg, pneumonia, ateiectasis, and wound complications) and febrile morbidity occurred equaliy in both groups. There were no known anastamotic complications or aspirations in either group. Postoperative changes in hematologic indices and electrolytes were comparable in both groups. Conclusion: Early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery is safe and well tolerated.
Editorial Comment: Not too many years ago, use of a nasogastric tube until active bowel munds were present and the patient was passing flatus was the usual standard of care after mqjor intra-abdominalprocedures. The pendulum certainly has swung toward earlier resumption of oral feeding, even in cases of bowel anastomosis. This randomized trial demonstrated that patients who were started on dietary intake sooner had no increase in complications and were able to leave the hospital earlier. There was more nausea reported in the early feeding group but only 3%of patients required insertion of a nasogastric tube. Joseph A. Smith, Jr., M.D. Mechanical Bowel Preparation for Elective Colorectal Surgery: A Prospective, Randomized, Surgeon-Blinded Trial Comparing Sodium Phosphate and Polyethylene Glycol-Based Oral Lavage Solutions L. OLNEIRA, S. D. WEXNER,N. DANIEL, D. D E W T A E. , G. WEISS,J. J. NOGUERAS AND M. BERNSTEIN, Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida Dis. Colon Rectum, 40:585-591,1997 AIM:The aim of this study was to compare the cleansing ability, patient compliance, and safety of two oral solutions for elective colorectal surgery. METHODS: All eligible patients were prospectively randomized to receive either 4 1 of standard polyethylene glycol (PEG) solution o r 90 ml of sodium phosphate (Nap) as mechanical bowel preparation for colorectal surgery. A detailed questionnaire was used to assess patient compliance. In addition, the surgeons, blinded to the preparation, intraoperatively evaluated its quality. Postoperative septic complications were also assessed. The calcium serum level was monitored before and after bowel preparation. Statistical analysis was performed using the Wilcoxon’s rank-sum test and Fisher’s exact test. RESULTS: Two hundred patients, well matched for age, gender, and diagnosis, were prospectively randomized to receive either PEG or NaF’ solutions for elective colorectal surgery. All patients completed all phases of the trial. There was a significant decrease in serum calcium levels aRer administration of both NaP (mean, 9.3-8.8 mg/dl) and PEG (9.2-8.9 mg/dl), respectively (P <0.0001), with no clinical sequelae. However, patient tolerance to NaP was superior to P E G less trouble drinking the preparation (17 vs. 32 percent; P <0.0002), less abdominal pain (12 vs. 22 percent; P = 0.004),less bloating (7 VS. 28 percent), and less fatigue (8 vs. 17 percent), respectively. Additionally, 65 percent of patients who received the NaP preparation stated they would repeat this preparation again compared with only 25 percent for the PEG group (P <0.0001). Ninety-five percent of patients who received the NaP solution tolerated 100 percent of the solution compared with only 37 percent of the PEG group (P <0.0001). For quality of cleansing, surgeons scored NaP as “excellent”or “good”in 87 compared with 76 percent after PEG (P= not significant). Rates of septic and anastomotic complications were 1 percent and 1 percent for NaP