title: To eat or not to eat: facilitating early oral intake after elective colonic surgery in the Netherlands.
abstract: OBJECTIVE
  It was shown that patients in the Netherlands remain exposed to unnecessarily prolonged starvation after abdominal surgery. The present study examined whether a structured collaborative effort would help to implement the early start of oral nutrition after colorectal surgery.
  
  
  METHODS
  In 2006, twenty-six Dutch hospitals signed up to a "breakthrough project" concerning the implementation of the enhanced recovery after surgery (ERAS) programme with early oral feeding as one of the key elements. Each hospital determined the usual start of food intake by analyzing 50 patients who underwent a colorectal resection in 2004 (n=1126). Subsequently, over the course of one year 861 colorectal surgery patients were treated according to the ERAS programme. The first day that patients were eating before and after the breakthrough project was compared using Kaplan-Meier analyses and Cox regression models.
  
  
  RESULTS
  Patients treated according to the ERAS programme were eating 3 days earlier than the patients traditionally treated (p<0.000). Two days after surgery 65% of the ERAS patients were eating normal food versus 7% of the pre-ERAS patients.
  
  
  CONCLUSIONS
  The present nationwide collaborative effort was successful in implementing a change towards an early start of oral nutrition after abdominal surgery.
authors.affiliation: Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands. jose.maessen@mucm.nl
authors.forename: J M C
authors.initials: JM
authors.lastname: Maessen
authors.forename: C
authors.initials: C
authors.lastname: Hoff
authors.forename: K
authors.initials: K
authors.lastname: Jottard
authors.forename: A G H
authors.initials: AG
authors.lastname: Kessels
authors.forename: A J
authors.initials: AJ
authors.lastname: Bremers
authors.forename: K
authors.initials: K
authors.lastname: Havenga
authors.forename: R J
authors.initials: RJ
authors.lastname: Oostenbroek
authors.forename: M F
authors.initials: MF
authors.lastname: von Meyenfeldt
authors.forename: C H C
authors.initials: CH
authors.lastname: Dejong
mesh_terms: D000368:Aged; D003106:Colon / Q000601:surgery*; D000075202:Contraindications; D004435:Eating / Q000502:physiology; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D053208:Kaplan-Meier Estimate; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011182:Postoperative Care / Q000592:standards*; D011184:Postoperative Period; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D012007:Rectum / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome