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

Nutr J. 2017 Feb 10;16(1):11. doi: 10.1186/s12937-017-0228-7.

Abstract

Background & aims: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Trial registration: Registration number: ChiCTR-TRC-14004395 . Registered 15 March 2014.

Keywords: Cost-effectiveness analysis; Multi-modal early oral nutrition (multimodal EON); Postoperative ileus (POI).

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen / surgery*
  • Aged
  • Colectomy
  • Cost-Benefit Analysis
  • Defecation / physiology
  • Digestive System Surgical Procedures*
  • Endpoint Determination
  • Female
  • Gastrectomy
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Nutritional Status
  • Nutritional Support*
  • Postoperative Care / methods*
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Sample Size
  • Single-Blind Method

Associated data

  • ChiCTR/ChiCTR-TRC-14004395