title: Safety, feasibility, and tolerance of early oral feeding after colorectal resection outside an enhanced recovery after surgery (ERAS) program.
abstract: BACKGROUND
  It is generally believed that resumption of feeding after colorectal resection is indicated only after recovery of bowel function. This study was designed to verify safety, feasibility, and tolerance of early oral postoperative feeding (EOF) outside an enhanced recovery after surgery (ERAS) program.
  
  
  METHODS
  One hundred patient candidates to elective colorectal resection were prospectively enrolled in an EOF program. Feeding was started on postoperative day (POD) 1 with oral nutritional supplement (ONS). On POD 2, patients had normal food plus ONS to reach 1,000-1,200 kcal/day with progressive increase until 1,800-2,000 kcal/day. Results were compared with historical controls (n = 100) in whom oral feeding was allowed only after full bowel function recovery. The ERAS program was not applied in both groups.
  
  
  RESULTS
  The EOF group had a better recovery of short half-life protein synthesis compared with the control group (P < 0.001). Stool canalization occurred after a median of 3 days (range, 1-6 days) in the EOF group versus 5 days (range, 2-8 days) in the control group (P = 0.001). The feeding protocol was completed in 89 patients within POD 5. Tolerance to resumption of feeding was similar in the two groups. The overall rate of postoperative complication was 22% in the EOF group vs. 27% in the control group (P = 0.51). The median length of hospitalization was 9 days (range, 6-25 days) in the EOF group vs. 12 days (range, 6-31 days) in controls (P = 0.01).
  
  
  CONCLUSIONS
  EOF after colorectal operations is feasible and safe outside an ERAS program.
authors.affiliation: Department of Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy. luca.gianotti@unimib.it
authors.forename: Luca
authors.initials: L
authors.lastname: Gianotti
authors.forename: Luca
authors.initials: L
authors.lastname: Nespoli
authors.forename: Laura
authors.initials: L
authors.lastname: Torselli
authors.forename: Mariarita
authors.initials: M
authors.lastname: Panelli
authors.forename: Angelo
authors.initials: A
authors.lastname: Nespoli
mesh_terms: D000284:Administration, Oral; D003107:Colorectal Surgery / Q000379:methods*; D005240:Feasibility Studies; D005248:Feeding Methods / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011182:Postoperative Care; D020127:Recovery of Function / Q000502:physiology*