title: Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis.
abstract: BACKGROUND
  A meta-analysis evaluating surgical outcomes following nutritional provision provided proximal to the anastomosis within 24 hours of gastrointestinal surgery compared with traditional postoperative management was conducted.
  
  
  METHODS
  Databases were searched to identify randomized controlled trials comparing the outcomes of early and traditional postoperative feeding. Trials involving gastrointestinal tract resection followed by patients receiving nutritionally significant oral or enteral intake within 24 hours after surgery were included for analysis.
  
  
  RESULTS
  Fifteen studies involving a total of 1240 patients were analyzed. A statistically significant reduction (45%) in relative odds of total postoperative complications was seen in patients receiving early postoperative feeding (odds ratio [OR] 0.55; confidence interval [CI], 0.35 -0.87, P = .01). No effect of early feeding was seen with relation to anastomotic dehiscence (OR 0.75; CI, 0.39-1.4, P = .39), mortality (OR 0.71; CI, 0.32-1.56, P = .39), days to passage of flatus (weighted mean difference [WMD] -0.42; CI, -1.12 to 0.28, P = .23), first bowel motion (WMD -0.28; CI, -1.20 to 0.64, P = .55), or reduced length of stay (WMD -1.28; CI, -2.94 to 0.38, P = .13); however, the direction of clinical outcomes favored early feeding. Nasogastric tube reinsertion was less common in traditional feeding interventions (OR 1.48; CI, 0.93-2.35, P = .10).
  
  
  CONCLUSIONS
  Early postoperative nutrition is associated with significant reductions in total complications compared with traditional postoperative feeding practices and does not negatively affect outcomes such as mortality, anastomotic dehiscence, resumption of bowel function, or hospital length of stay.
authors.affiliation: Department of Surgery and Nutrition, Ipswich Hospital, Ipswich, Queensland, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Osland
authors.forename: Rossita Mohamad
authors.initials: RM
authors.lastname: Yunus
authors.forename: Shahjahan
authors.initials: S
authors.lastname: Khan
authors.forename: Muhammed Ashraf
authors.initials: MA
authors.lastname: Memon
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures; D004750:Enteral Nutrition / Q000379:methods; D006801:Humans; D007902:Length of Stay; D016017:Odds Ratio; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000628:therapy*; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome