Comparison of multi-modal early oral nutrition for the tolerance of oral nutrition with conventional care after major abdominal surgery: a prospective, randomized, single-blind trial.
Early oral nutrition (EON) has been shown to improve recovery of gastrointestinal function, length of stay and mortality after abdominal surgery; however, early oral nutrition often fails during the first week after surgery. Here, a multi-modal early oral nutrition program is introduced to promote recovery of gastrointestinal function and tolerance of oral nutrition.



Consecutive patients scheduled for abdominal surgery were randomized to the multimodal EON group or a group receiving conventional care. The primary endpoint was the time of first defecation. The secondary endpoints were outcomes and the cost-effectiveness ratio in treating infectious complications. The rate of infectious-free patients was regarded as the index of effectiveness.



One hundred seven patients were randomly assigned to groups. Baseline characteristics were similar for both groups. In intention-to-treat analysis, the success rate of oral nutrition during the first week after surgery in the multimodal EON group was 44 (83.0%) versus 31 (57.4%) in the conventional care group (P = 0.004). Time to first defecation, time to flatus, recovery time of bowel sounds, and prolonged postoperative ileus were all less in the multimodal EON group (P < 0.05). The median postoperative length of stay in the multimodal EON group was 8 days (6, 12) versus 10 days (7, 18) in the conventional care group (P < 0.001). The total cost of treatment and nutritional support were also less in the multi-modal early oral nutrition group (P < 0.001). The effectiveness was 84.9 and 79.9% in the multimodal EON and conventional care group, respectively (P = 0.475). However, the cost-effectiveness ratio was USD 537.6 (506.1, 589.3) and USD 637.8 (593.9, 710.3), respectively (P < 0.001).



The multi-modal early oral nutrition program was an effective way to improve tolerance of oral nutrition during the first week after surgery, decrease the length of stay and improve cost-effectiveness after abdominal surgery.



Registration number: ChiCTR-TRC-14004395 . Registered 15 March 2014.
Department of General Surgery, Wuhan Clinical School of Southern Medical University/Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430070, China.|Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
Da-Li
DL
Sun
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
Wei-Ming
WM
Li
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
Shu-Min
SM
Li
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
Yun-Yun
YY
Cen
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
Qing-Wen
QW
Xu
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
Yi-Jun
YJ
Li
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
Yan-Bo
YB
Sun
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
Yu-Xing
YX
Qi
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
Yue-Ying
YY
Lin
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
Ting
T
Yang
Department of General Surgery, Wuhan Clinical School of Southern Medical University/Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430070, China. ptwklqp111@163.com.
Qi-Ping
QP
Lu
Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China. destiny1978@163.com.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China. destiny1978@163.com.
Peng-Yuan
PY
Xu
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D003082:Colectomy; D003362:Cost-Benefit Analysis; D003672:Defecation / Q000502:physiology; D013505:Digestive System Surgical Procedures; D023381:Endpoint Determination; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D018529:Nutritional Support; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D018401:Sample Size; D016037:Single-Blind Method
Cost-effectiveness analysis; Multi-modal early oral nutrition (multimodal EON); Postoperative ileus (POI)