Early Postoperative Feeding in Gynecologic Oncology Patients Receiving Abdominal Surgery
ABSTRACT & COMMENTARY
Synopsis: Early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery is safe and well tolerated.
Source: Pearl ML, et al. Obstet Gynecol 1998;92:94-97.
Pearl and colleagues report a randomized controlled trial designed to evaluate the safety and efficacy of early oral feeding after intra-abdominal surgery in gynecologic oncology patients. During a one-year period, 200 patients were enrolled in this trial that compared early with traditional oral postoperative feeding. Patients allocated to early postoperative oral feeding began a clear liquid diet on the first postoperative day and then advanced to a regular diet as tolerated. Patients allocated to traditional postoperative oral feeding received nothing by mouth until return of bowel function (defined as the passage of flatus in the absence of vomiting or abdominal distention), then began a clear liquid diet, and advanced to a regular diet as tolerated. The two groups were similar in terms of age, case distribution, length of surgery, blood loss, and first passage of flatus. Significantly, more patients in the early group developed nausea. Despite this, the incidence of nasogastric tube use and the percentage of patients who tolerated clear liquid and regular diets on the first attempt were comparable in both groups. Time to development of bowel sounds, time to initiation of clear liquid and regular diets, and hospital stay were significantly longer in the traditional group. Major complications (e.g., pneumonia, atelectasis, and wound complications) and febrile morbidity occurred equally in both groups. There were no known anastamotic complications or aspirations in either group. Postoperative change in hematologic indices and electrolytes were comparable in both groups. Pearl and associates conclude that early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery is safe and well tolerated.
COMMENT BY DAVID M. GERSHENSON, MD
As I have opined in these pages previously, one of the few good aspects of healthcare reform and managed care has been the need to reexamine many of our practice patterns that have been based strictly on dogma rather than on evidence-based medicine. The postoperative management of the gastrointestinal tract in gynecology patients has been one of these practices. Most of us are products of our residency training, in that we still retain at least some of the dogma we were taught by our professors or senior residents. Pearl et al should be applauded for systematically studying this area. They previously reported a prospective randomized trial, the findings of which suggested that nasogastric tube decompression after gynecologic surgery is not warranted, except in selected situations (Obstet Gynecol 1996;88:399-402). They now have addressed the second major question regarding postoperative management of the GI tract-do we need to wait for evidence of flatus until we feed patients? And, their findings validate what most of us are observing in our surgically oriented care pathways-the answer is no. As long as major problems are not encountered, early feeding translates into earlier hospital discharge, which, in turn, reduces the cost of medical care. Our group is now in the process of fine-tuning our postoperative feeding regimen by administering antiemetic medication intraoperatively, delaying clear liquids on the morning of the first postoperative day (in an effort to reduce the nausea observed by Pearl et al), and administering non-oral analgesics until the second postoperative day.