Benefits of early feeding and early hospital discharge in elderly patients undergoing open colon resection.
BACKGROUND
Recent studies have demonstrated a reduction in hospital stay and postoperative complications in elderly patients undergoing laparoscopy-assisted colectomy, and have attributed the shorter stays and reduced morbidity to the laparoscopic approach. We questioned whether the improved outcomes in these studies were a result of the laparoscopic procedure alone or a result of early postoperative feeding and early hospital discharge. We hypothesized that early feeding in elderly patients undergoing open colorectal resection results in a short hospital stay and favorably affects postoperative morbidity.


METHODS
Patients aged 70 years and older who were undergoing elective open colon resection were placed on an early postoperative feeding protocol. The early feeding protocol consisted of clear liquids on postoperative day 2, regular diet on postoperative day 3, and discharge to home as tolerated. The main outcomes measurements included early feeding tolerance, hospital stay, postoperative morbidity, and requirement for postoperative assisted care.


RESULTS
There were 87 study patients (42 men and 45 women, mean age 77 years). The most common operation was right hemicolectomy (53%). Overall 78 of 87 patients (89.6%) tolerated early feeding. Five patients (5.7%) initially tolerated a diet but required readmission for ileus. Nine patients (10.4%) did not tolerate early feeding initially. The mean hospital stay for all patients was 3.9 days. There were 15 postoperative complications in 13 patients (14.9%), the most common of which was urinary retention. There were no deaths, anastomotic leaks, abscesses, or pneumonia. Only 3 of 86 patients (3.5%) who were previously independent required assisted care after colectomy.


CONCLUSIONS
In elderly patients undergoing elective open colon resection, early feeding results in a short hospital stay and low postoperative morbidity. These results are comparable to those reported for laparoscopy-assisted colectomy.
Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, CA, USA.
L Andrew
LA
DiFronzo
Nader
N
Yamin
Kaushal
K
Patel
Theodore X
TX
O'Connell
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D045823:Ileus / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data*; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D009017:Morbidity; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology