Tolerance to and Postoperative Outcomes With Early Oral Feeding Following Elective Bowel Surgery: A Systematic Review

Abstract

Although practice guidelines recommend resuming oral feeding immediatelyafter gastrointestinal surgery, many practitioners remain reluctant toorder early oral feeding (EOF). Therefore, this review aimed to clarifythe tolerance to and postoperative outcomes with EOF among patientsundergoing bowel surgery. A systematic review of the literature publishedbetween January 1990 and July 2022 with the time of oral intake (early ordelayed until resolution of ileus) as the exposure variable was conductedusing PubMed and Scopus databases. Outcomes of interest included toleranceto EOF and postoperative adverse effects or complications. After screening1,667 research articles, 18 randomized control trials, six prospectivecase series, and four cohort studies met our inclusion criteria,collectively representing data from 2,647 patients in eleven countries.These studies indicate that while most patients tolerate EOF, 5-25% maynot tolerate EOF until the fourth postoperative day (POD). Moreover, EOF,at best, has no advantage over delayed feeding in terms of vomiting,nausea, nasogastric tube requirement, or other postoperativecomplications. In addition, early return of bowel function, lower risk ofdiarrhea, and lower pain score with EOF are inconsistently reported, andshorter hospitalization with EOF may be limited to those who tolerate oralfeeding on POD 0 or 1. Nevertheless, shorter hospitalization with EOFcould reduce the cost of hospitalization. A substantial number of patientsmay not be able to tolerate oral feeding after bowel surgery until POD 4,and in patients who tolerate EOF, the only clear benefit is a shorterlength of hospitalization. Copyright © 2023, Mvoula et al.