Early versus delayed oral feeding after major gynaecologic surgery
Background This is an updated and expanded version of the original Cochrane review, first published in 2014. Postoperative oral intake is traditionally withheld after major abdominal gynaecologic surgery until the return of bowel function. The concern is that early oral intake will result in vomitin...
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| creator | Charoenkwan, Kittipat Charoenkwan, Kittipat Nantasupha, Chalaithorn Muangmool, Tanarat Matovinovic, Elizabeth |
| description | Background
This is an updated and expanded version of the original Cochrane review, first published in 2014. Postoperative oral intake is traditionally withheld after major abdominal gynaecologic surgery until the return of bowel function. The concern is that early oral intake will result in vomiting and severe paralytic ileus, with subsequent aspiration pneumonia, wound dehiscence, and anastomotic leakage. However, clinical studies suggest that there may be benefits from early postoperative oral intake. Currently, gynaecologic surgery can be performed through various routes: open abdominal, vaginal, laparoscopic, robotic, or a combination. In this version, we included women undergoing major gynaecologic surgery through all of these routes, either alone or in combination.
Objectives
To assess the effects of early versus delayed (traditional) initiation of oral intake of food and fluids after major gynaecologic surgery.
Search methods
On 13 June 2023, we searched the Cochrane Gynaecology and Fertility Group's Specialised Register, CENTRAL, MEDLINE, Embase, the citation lists of relevant publications, and two trial registries. We also contacted experts in the field for any additional studies.
Selection criteria
We included randomised controlled trials (RCTs) that compared the effect of early versus delayed initiation of oral intake of food and fluids after major gynaecologic surgery, performed by abdominal, vaginal, laparoscopic, and robotic approaches. Early feeding was defined as oral intake of fluids or food within 24 hours post‐surgery, regardless of the return of bowel function. Delayed feeding was defined as oral intake after 24 hours post‐surgery, and only after signs of postoperative ileus resolution. Primary outcomes were: postoperative ileus, nausea, vomiting, cramping, abdominal pain, bloating, abdominal distension, need for postoperative nasogastric tube, time to the presence of bowel sounds, time to the first passage of flatus, time to the first passage of stool, time to the start of a regular diet, and length of postoperative hospital stay. Secondary outcomes were: infectious complications, wound complications, deep venous thrombosis, urinary tract infection, pneumonia, satisfaction, and quality of life.
Data collection and analysis
Two review authors independently selected studies, assessed the risk of bias, and extracted the data. We calculated the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous data. We examined continuou |
| doi_str_mv | 10.1002/14651858.CD004508.pub5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1002_14651858_CD004508_pub5</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3092012110</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1625-42c75df90994052e4013aaace620ce4c19c6861a3d3e3fa6c89acc444f9578213</originalsourceid><addsrcrecordid>eNqFkMtKw0AUhgdRrFZfoczSTerck1naWi9QcKPrYTo5iSmTps40St7ehLYiblydA_8NPoQmlEwpIeyWCiVpJrPp_J4QIUk23bYreYIuBiEZlNNf_whdxrgmhCvN0nM04ppylgp-gWYLG3yHPyHENuIcvO0gx02wHhcAebUpsS12EHBt103AZbex4BrflJXDsQ0lhO4KnRXWR7g-3DF6e1i8zp-S5cvj8_xumTiqmEwEc6nMC020FkQyEIRya60DxYgD4ah2KlPU8pwDL6xymbbOCSEKLdOMUT5GN_vebWg-Wog7U1fRgfd2A00bDSeaEcooJb1V7a0uNDEGKMw2VLUNnaHEDPzMkZ858jMDvz44OWy0qxryn9gRWG-Y7Q1flYfOuMa9h37_n94_K9-Bh3-X</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3092012110</pqid></control><display><type>article</type><title>Early versus delayed oral feeding after major gynaecologic surgery</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Charoenkwan, Kittipat ; Charoenkwan, Kittipat ; Nantasupha, Chalaithorn ; Muangmool, Tanarat ; Matovinovic, Elizabeth</creator><creatorcontrib>Charoenkwan, Kittipat ; Charoenkwan, Kittipat ; Nantasupha, Chalaithorn ; Muangmool, Tanarat ; Matovinovic, Elizabeth</creatorcontrib><description>Background
This is an updated and expanded version of the original Cochrane review, first published in 2014. Postoperative oral intake is traditionally withheld after major abdominal gynaecologic surgery until the return of bowel function. The concern is that early oral intake will result in vomiting and severe paralytic ileus, with subsequent aspiration pneumonia, wound dehiscence, and anastomotic leakage. However, clinical studies suggest that there may be benefits from early postoperative oral intake. Currently, gynaecologic surgery can be performed through various routes: open abdominal, vaginal, laparoscopic, robotic, or a combination. In this version, we included women undergoing major gynaecologic surgery through all of these routes, either alone or in combination.
Objectives
To assess the effects of early versus delayed (traditional) initiation of oral intake of food and fluids after major gynaecologic surgery.
Search methods
On 13 June 2023, we searched the Cochrane Gynaecology and Fertility Group's Specialised Register, CENTRAL, MEDLINE, Embase, the citation lists of relevant publications, and two trial registries. We also contacted experts in the field for any additional studies.
Selection criteria
We included randomised controlled trials (RCTs) that compared the effect of early versus delayed initiation of oral intake of food and fluids after major gynaecologic surgery, performed by abdominal, vaginal, laparoscopic, and robotic approaches. Early feeding was defined as oral intake of fluids or food within 24 hours post‐surgery, regardless of the return of bowel function. Delayed feeding was defined as oral intake after 24 hours post‐surgery, and only after signs of postoperative ileus resolution. Primary outcomes were: postoperative ileus, nausea, vomiting, cramping, abdominal pain, bloating, abdominal distension, need for postoperative nasogastric tube, time to the presence of bowel sounds, time to the first passage of flatus, time to the first passage of stool, time to the start of a regular diet, and length of postoperative hospital stay. Secondary outcomes were: infectious complications, wound complications, deep venous thrombosis, urinary tract infection, pneumonia, satisfaction, and quality of life.
Data collection and analysis
Two review authors independently selected studies, assessed the risk of bias, and extracted the data. We calculated the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous data. We examined continuous data using the mean difference (MD) and a 95% CI. We tested for heterogeneity between the results of different studies using a forest plot of the meta‐analysis, the statistical tests of homogeneity of 2 x 2 tables, and the I² value. We assessed the certainty of the evidence using GRADE methods.
Main results
We included seven randomised controlled trials (RCTs), randomising 902 women.
We are uncertain whether early feeding compared to delayed feeding has an effect on postoperative ileus (RR 0.49, 95% CI 0.21 to 1.16; I² = 0%; 4 studies, 418 women; low‐certainty evidence). We are uncertain whether early feeding affects nausea or vomiting, or both (RR 0.94, 95% CI 0.66 to 1.33; I² = 67%; random‐effects model; 6 studies, 742 women; very low‐certainty evidence); nausea (RR 1.24, 95% CI 0.51 to 3.03; I² = 74%; 3 studies, 453 women; low‐certainty evidence); vomiting (RR 0.83, 95% CI 0.52 to 1.32; I² = 0%; 4 studies, 559 women; low‐certainty evidence), abdominal distension (RR 0.99, 95% CI 0.75 to 1.31; I² = 0%; 4 studies, 559 women; low‐certainty evidence); need for postoperative nasogastric tube placement (RR 0.46, 95% CI 0.14 to 1.55; 3 studies, 453 women; low‐certainty evidence); or time to the presence of bowel sounds (MD ‐0.20 days, 95% CI ‐0.46 to 0.06; I² = 71%; random‐effects model; 3 studies, 477 women; low‐certainty evidence).
There is probably no difference between the two feeding protocols for the onset of flatus (MD ‐0.11 days, 95% CI ‐0.23 to 0.02; I² = 9%; 5 studies, 702 women; moderate‐certainty evidence).
Early feeding probably results in a slight reduction in the time to the first passage of stool (MD ‐0.18 days, 95% CI ‐0.33 to ‐0.04; I² = 0%; 4 studies, 507 women; moderate‐certainty evidence), and may lead to a slightly sooner resumption of a solid diet (MD ‐1.10 days, 95% CI ‐1.79 to ‐0.41; I² = 97%; random‐effects model; 3 studies, 420 women; low‐certainty evidence). Hospital stay may be slightly shorter in the early feeding group (MD ‐0.66 days, 95% CI ‐1.17 to ‐0.15; I² = 77%; random‐effects model; 5 studies, 603 women; low‐certainty evidence).
The effect of the two feeding protocols on febrile morbidity is uncertain (RR 0.96, 95% CI 0.75 to 1.22; I² = 47%; 3 studies, 453 women; low‐certainty evidence). However, infectious complications are probably less common in women with early feeding (RR 0.20, 95% CI 0.05 to 0.73; I² = 0%; 2 studies, 183 women; moderate‐certainty evidence). There may be no difference between the two feeding protocols for wound complications (RR 0.82, 95% CI 0.50 to 1.35; I² = 0%; 4 studies, 474 women; low‐certainty evidence), or pneumonia (RR 0.35, 95% CI 0.07 to 1.73; I² = 0%; 3 studies, 434 women; low‐certainty evidence).
Two studies measured participant satisfaction and quality of life. One study found satisfaction was probably higher in the early feeding group, while the other study found no difference. Neither study found a significant difference between the groups for quality of life (P > 0.05).
Authors' conclusions
Despite some uncertainty, there is no evidence to indicate harmful effects of early feeding following major gynaecologic surgery, measured as postoperative ileus, nausea, vomiting, or abdominal distension. The potential benefits of early feeding include a slightly faster initiation of bowel movements, a slightly sooner resumption of a solid diet, a slightly shorter hospital stay, a lower rate of infectious complications, and a higher level of satisfaction.</description><identifier>ISSN: 1465-1858</identifier><identifier>ISSN: 1469-493X</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD004508.pub5</identifier><identifier>PMID: 39132743</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Bias ; Drinking ; Eating ; Enteral Nutrition ; Enteral Nutrition - methods ; Female ; GYNAECOLOGICAL SURGERY (excluding malignant conditions but including complications after surgery) ; Gynaecology ; Gynecologic Surgical Procedures ; Gynecologic Surgical Procedures - adverse effects ; Humans ; Intestinal Pseudo-Obstruction ; Intestinal Pseudo-Obstruction - etiology ; Length of Stay ; Medicine General & Introductory Medical Sciences ; Other ; POST-OPERATIVE COMPLICATIONS FOLLOWING GYNAECOLOGICAL SURGERY (e.g. urinary retention, thromboembolism) ; Postoperative Care ; Postoperative Care - methods ; Postoperative Complications ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Postoperative Nausea and Vomiting ; Postoperative Nausea and Vomiting - epidemiology ; Postoperative Nausea and Vomiting - etiology ; Randomized Controlled Trials as Topic ; Surgery ; Time Factors</subject><ispartof>Cochrane database of systematic reviews, 2024-08, Vol.2024 (8), p.CD004508</ispartof><rights>Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1625-42c75df90994052e4013aaace620ce4c19c6861a3d3e3fa6c89acc444f9578213</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27911,27912</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39132743$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Charoenkwan, Kittipat</creatorcontrib><creatorcontrib>Charoenkwan, Kittipat</creatorcontrib><creatorcontrib>Nantasupha, Chalaithorn</creatorcontrib><creatorcontrib>Muangmool, Tanarat</creatorcontrib><creatorcontrib>Matovinovic, Elizabeth</creatorcontrib><title>Early versus delayed oral feeding after major gynaecologic surgery</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
This is an updated and expanded version of the original Cochrane review, first published in 2014. Postoperative oral intake is traditionally withheld after major abdominal gynaecologic surgery until the return of bowel function. The concern is that early oral intake will result in vomiting and severe paralytic ileus, with subsequent aspiration pneumonia, wound dehiscence, and anastomotic leakage. However, clinical studies suggest that there may be benefits from early postoperative oral intake. Currently, gynaecologic surgery can be performed through various routes: open abdominal, vaginal, laparoscopic, robotic, or a combination. In this version, we included women undergoing major gynaecologic surgery through all of these routes, either alone or in combination.
Objectives
To assess the effects of early versus delayed (traditional) initiation of oral intake of food and fluids after major gynaecologic surgery.
Search methods
On 13 June 2023, we searched the Cochrane Gynaecology and Fertility Group's Specialised Register, CENTRAL, MEDLINE, Embase, the citation lists of relevant publications, and two trial registries. We also contacted experts in the field for any additional studies.
Selection criteria
We included randomised controlled trials (RCTs) that compared the effect of early versus delayed initiation of oral intake of food and fluids after major gynaecologic surgery, performed by abdominal, vaginal, laparoscopic, and robotic approaches. Early feeding was defined as oral intake of fluids or food within 24 hours post‐surgery, regardless of the return of bowel function. Delayed feeding was defined as oral intake after 24 hours post‐surgery, and only after signs of postoperative ileus resolution. Primary outcomes were: postoperative ileus, nausea, vomiting, cramping, abdominal pain, bloating, abdominal distension, need for postoperative nasogastric tube, time to the presence of bowel sounds, time to the first passage of flatus, time to the first passage of stool, time to the start of a regular diet, and length of postoperative hospital stay. Secondary outcomes were: infectious complications, wound complications, deep venous thrombosis, urinary tract infection, pneumonia, satisfaction, and quality of life.
Data collection and analysis
Two review authors independently selected studies, assessed the risk of bias, and extracted the data. We calculated the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous data. We examined continuous data using the mean difference (MD) and a 95% CI. We tested for heterogeneity between the results of different studies using a forest plot of the meta‐analysis, the statistical tests of homogeneity of 2 x 2 tables, and the I² value. We assessed the certainty of the evidence using GRADE methods.
Main results
We included seven randomised controlled trials (RCTs), randomising 902 women.
We are uncertain whether early feeding compared to delayed feeding has an effect on postoperative ileus (RR 0.49, 95% CI 0.21 to 1.16; I² = 0%; 4 studies, 418 women; low‐certainty evidence). We are uncertain whether early feeding affects nausea or vomiting, or both (RR 0.94, 95% CI 0.66 to 1.33; I² = 67%; random‐effects model; 6 studies, 742 women; very low‐certainty evidence); nausea (RR 1.24, 95% CI 0.51 to 3.03; I² = 74%; 3 studies, 453 women; low‐certainty evidence); vomiting (RR 0.83, 95% CI 0.52 to 1.32; I² = 0%; 4 studies, 559 women; low‐certainty evidence), abdominal distension (RR 0.99, 95% CI 0.75 to 1.31; I² = 0%; 4 studies, 559 women; low‐certainty evidence); need for postoperative nasogastric tube placement (RR 0.46, 95% CI 0.14 to 1.55; 3 studies, 453 women; low‐certainty evidence); or time to the presence of bowel sounds (MD ‐0.20 days, 95% CI ‐0.46 to 0.06; I² = 71%; random‐effects model; 3 studies, 477 women; low‐certainty evidence).
There is probably no difference between the two feeding protocols for the onset of flatus (MD ‐0.11 days, 95% CI ‐0.23 to 0.02; I² = 9%; 5 studies, 702 women; moderate‐certainty evidence).
Early feeding probably results in a slight reduction in the time to the first passage of stool (MD ‐0.18 days, 95% CI ‐0.33 to ‐0.04; I² = 0%; 4 studies, 507 women; moderate‐certainty evidence), and may lead to a slightly sooner resumption of a solid diet (MD ‐1.10 days, 95% CI ‐1.79 to ‐0.41; I² = 97%; random‐effects model; 3 studies, 420 women; low‐certainty evidence). Hospital stay may be slightly shorter in the early feeding group (MD ‐0.66 days, 95% CI ‐1.17 to ‐0.15; I² = 77%; random‐effects model; 5 studies, 603 women; low‐certainty evidence).
The effect of the two feeding protocols on febrile morbidity is uncertain (RR 0.96, 95% CI 0.75 to 1.22; I² = 47%; 3 studies, 453 women; low‐certainty evidence). However, infectious complications are probably less common in women with early feeding (RR 0.20, 95% CI 0.05 to 0.73; I² = 0%; 2 studies, 183 women; moderate‐certainty evidence). There may be no difference between the two feeding protocols for wound complications (RR 0.82, 95% CI 0.50 to 1.35; I² = 0%; 4 studies, 474 women; low‐certainty evidence), or pneumonia (RR 0.35, 95% CI 0.07 to 1.73; I² = 0%; 3 studies, 434 women; low‐certainty evidence).
Two studies measured participant satisfaction and quality of life. One study found satisfaction was probably higher in the early feeding group, while the other study found no difference. Neither study found a significant difference between the groups for quality of life (P > 0.05).
Authors' conclusions
Despite some uncertainty, there is no evidence to indicate harmful effects of early feeding following major gynaecologic surgery, measured as postoperative ileus, nausea, vomiting, or abdominal distension. The potential benefits of early feeding include a slightly faster initiation of bowel movements, a slightly sooner resumption of a solid diet, a slightly shorter hospital stay, a lower rate of infectious complications, and a higher level of satisfaction.</description><subject>Bias</subject><subject>Drinking</subject><subject>Eating</subject><subject>Enteral Nutrition</subject><subject>Enteral Nutrition - methods</subject><subject>Female</subject><subject>GYNAECOLOGICAL SURGERY (excluding malignant conditions but including complications after surgery)</subject><subject>Gynaecology</subject><subject>Gynecologic Surgical Procedures</subject><subject>Gynecologic Surgical Procedures - adverse effects</subject><subject>Humans</subject><subject>Intestinal Pseudo-Obstruction</subject><subject>Intestinal Pseudo-Obstruction - etiology</subject><subject>Length of Stay</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Other</subject><subject>POST-OPERATIVE COMPLICATIONS FOLLOWING GYNAECOLOGICAL SURGERY (e.g. urinary retention, thromboembolism)</subject><subject>Postoperative Care</subject><subject>Postoperative Care - methods</subject><subject>Postoperative Complications</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Postoperative Nausea and Vomiting</subject><subject>Postoperative Nausea and Vomiting - epidemiology</subject><subject>Postoperative Nausea and Vomiting - etiology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Surgery</subject><subject>Time Factors</subject><issn>1465-1858</issn><issn>1469-493X</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFkMtKw0AUhgdRrFZfoczSTerck1naWi9QcKPrYTo5iSmTps40St7ehLYiblydA_8NPoQmlEwpIeyWCiVpJrPp_J4QIUk23bYreYIuBiEZlNNf_whdxrgmhCvN0nM04ppylgp-gWYLG3yHPyHENuIcvO0gx02wHhcAebUpsS12EHBt103AZbex4BrflJXDsQ0lhO4KnRXWR7g-3DF6e1i8zp-S5cvj8_xumTiqmEwEc6nMC020FkQyEIRya60DxYgD4ah2KlPU8pwDL6xymbbOCSEKLdOMUT5GN_vebWg-Wog7U1fRgfd2A00bDSeaEcooJb1V7a0uNDEGKMw2VLUNnaHEDPzMkZ858jMDvz44OWy0qxryn9gRWG-Y7Q1flYfOuMa9h37_n94_K9-Bh3-X</recordid><startdate>20240812</startdate><enddate>20240812</enddate><creator>Charoenkwan, Kittipat</creator><creator>Charoenkwan, Kittipat</creator><creator>Nantasupha, Chalaithorn</creator><creator>Muangmool, Tanarat</creator><creator>Matovinovic, Elizabeth</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240812</creationdate><title>Early versus delayed oral feeding after major gynaecologic surgery</title><author>Charoenkwan, Kittipat ; Charoenkwan, Kittipat ; Nantasupha, Chalaithorn ; Muangmool, Tanarat ; Matovinovic, Elizabeth</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1625-42c75df90994052e4013aaace620ce4c19c6861a3d3e3fa6c89acc444f9578213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Bias</topic><topic>Drinking</topic><topic>Eating</topic><topic>Enteral Nutrition</topic><topic>Enteral Nutrition - methods</topic><topic>Female</topic><topic>GYNAECOLOGICAL SURGERY (excluding malignant conditions but including complications after surgery)</topic><topic>Gynaecology</topic><topic>Gynecologic Surgical Procedures</topic><topic>Gynecologic Surgical Procedures - adverse effects</topic><topic>Humans</topic><topic>Intestinal Pseudo-Obstruction</topic><topic>Intestinal Pseudo-Obstruction - etiology</topic><topic>Length of Stay</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Other</topic><topic>POST-OPERATIVE COMPLICATIONS FOLLOWING GYNAECOLOGICAL SURGERY (e.g. urinary retention, thromboembolism)</topic><topic>Postoperative Care</topic><topic>Postoperative Care - methods</topic><topic>Postoperative Complications</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Postoperative Nausea and Vomiting</topic><topic>Postoperative Nausea and Vomiting - epidemiology</topic><topic>Postoperative Nausea and Vomiting - etiology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Surgery</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Charoenkwan, Kittipat</creatorcontrib><creatorcontrib>Charoenkwan, Kittipat</creatorcontrib><creatorcontrib>Nantasupha, Chalaithorn</creatorcontrib><creatorcontrib>Muangmool, Tanarat</creatorcontrib><creatorcontrib>Matovinovic, Elizabeth</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Charoenkwan, Kittipat</au><au>Charoenkwan, Kittipat</au><au>Nantasupha, Chalaithorn</au><au>Muangmool, Tanarat</au><au>Matovinovic, Elizabeth</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early versus delayed oral feeding after major gynaecologic surgery</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2024-08-12</date><risdate>2024</risdate><volume>2024</volume><issue>8</issue><spage>CD004508</spage><pages>CD004508-</pages><issn>1465-1858</issn><issn>1469-493X</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
This is an updated and expanded version of the original Cochrane review, first published in 2014. Postoperative oral intake is traditionally withheld after major abdominal gynaecologic surgery until the return of bowel function. The concern is that early oral intake will result in vomiting and severe paralytic ileus, with subsequent aspiration pneumonia, wound dehiscence, and anastomotic leakage. However, clinical studies suggest that there may be benefits from early postoperative oral intake. Currently, gynaecologic surgery can be performed through various routes: open abdominal, vaginal, laparoscopic, robotic, or a combination. In this version, we included women undergoing major gynaecologic surgery through all of these routes, either alone or in combination.
Objectives
To assess the effects of early versus delayed (traditional) initiation of oral intake of food and fluids after major gynaecologic surgery.
Search methods
On 13 June 2023, we searched the Cochrane Gynaecology and Fertility Group's Specialised Register, CENTRAL, MEDLINE, Embase, the citation lists of relevant publications, and two trial registries. We also contacted experts in the field for any additional studies.
Selection criteria
We included randomised controlled trials (RCTs) that compared the effect of early versus delayed initiation of oral intake of food and fluids after major gynaecologic surgery, performed by abdominal, vaginal, laparoscopic, and robotic approaches. Early feeding was defined as oral intake of fluids or food within 24 hours post‐surgery, regardless of the return of bowel function. Delayed feeding was defined as oral intake after 24 hours post‐surgery, and only after signs of postoperative ileus resolution. Primary outcomes were: postoperative ileus, nausea, vomiting, cramping, abdominal pain, bloating, abdominal distension, need for postoperative nasogastric tube, time to the presence of bowel sounds, time to the first passage of flatus, time to the first passage of stool, time to the start of a regular diet, and length of postoperative hospital stay. Secondary outcomes were: infectious complications, wound complications, deep venous thrombosis, urinary tract infection, pneumonia, satisfaction, and quality of life.
Data collection and analysis
Two review authors independently selected studies, assessed the risk of bias, and extracted the data. We calculated the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous data. We examined continuous data using the mean difference (MD) and a 95% CI. We tested for heterogeneity between the results of different studies using a forest plot of the meta‐analysis, the statistical tests of homogeneity of 2 x 2 tables, and the I² value. We assessed the certainty of the evidence using GRADE methods.
Main results
We included seven randomised controlled trials (RCTs), randomising 902 women.
We are uncertain whether early feeding compared to delayed feeding has an effect on postoperative ileus (RR 0.49, 95% CI 0.21 to 1.16; I² = 0%; 4 studies, 418 women; low‐certainty evidence). We are uncertain whether early feeding affects nausea or vomiting, or both (RR 0.94, 95% CI 0.66 to 1.33; I² = 67%; random‐effects model; 6 studies, 742 women; very low‐certainty evidence); nausea (RR 1.24, 95% CI 0.51 to 3.03; I² = 74%; 3 studies, 453 women; low‐certainty evidence); vomiting (RR 0.83, 95% CI 0.52 to 1.32; I² = 0%; 4 studies, 559 women; low‐certainty evidence), abdominal distension (RR 0.99, 95% CI 0.75 to 1.31; I² = 0%; 4 studies, 559 women; low‐certainty evidence); need for postoperative nasogastric tube placement (RR 0.46, 95% CI 0.14 to 1.55; 3 studies, 453 women; low‐certainty evidence); or time to the presence of bowel sounds (MD ‐0.20 days, 95% CI ‐0.46 to 0.06; I² = 71%; random‐effects model; 3 studies, 477 women; low‐certainty evidence).
There is probably no difference between the two feeding protocols for the onset of flatus (MD ‐0.11 days, 95% CI ‐0.23 to 0.02; I² = 9%; 5 studies, 702 women; moderate‐certainty evidence).
Early feeding probably results in a slight reduction in the time to the first passage of stool (MD ‐0.18 days, 95% CI ‐0.33 to ‐0.04; I² = 0%; 4 studies, 507 women; moderate‐certainty evidence), and may lead to a slightly sooner resumption of a solid diet (MD ‐1.10 days, 95% CI ‐1.79 to ‐0.41; I² = 97%; random‐effects model; 3 studies, 420 women; low‐certainty evidence). Hospital stay may be slightly shorter in the early feeding group (MD ‐0.66 days, 95% CI ‐1.17 to ‐0.15; I² = 77%; random‐effects model; 5 studies, 603 women; low‐certainty evidence).
The effect of the two feeding protocols on febrile morbidity is uncertain (RR 0.96, 95% CI 0.75 to 1.22; I² = 47%; 3 studies, 453 women; low‐certainty evidence). However, infectious complications are probably less common in women with early feeding (RR 0.20, 95% CI 0.05 to 0.73; I² = 0%; 2 studies, 183 women; moderate‐certainty evidence). There may be no difference between the two feeding protocols for wound complications (RR 0.82, 95% CI 0.50 to 1.35; I² = 0%; 4 studies, 474 women; low‐certainty evidence), or pneumonia (RR 0.35, 95% CI 0.07 to 1.73; I² = 0%; 3 studies, 434 women; low‐certainty evidence).
Two studies measured participant satisfaction and quality of life. One study found satisfaction was probably higher in the early feeding group, while the other study found no difference. Neither study found a significant difference between the groups for quality of life (P > 0.05).
Authors' conclusions
Despite some uncertainty, there is no evidence to indicate harmful effects of early feeding following major gynaecologic surgery, measured as postoperative ileus, nausea, vomiting, or abdominal distension. The potential benefits of early feeding include a slightly faster initiation of bowel movements, a slightly sooner resumption of a solid diet, a slightly shorter hospital stay, a lower rate of infectious complications, and a higher level of satisfaction.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>39132743</pmid><doi>10.1002/14651858.CD004508.pub5</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2024-08, Vol.2024 (8), p.CD004508 |
| issn | 1465-1858 1469-493X 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_crossref_primary_10_1002_14651858_CD004508_pub5 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Bias Drinking Eating Enteral Nutrition Enteral Nutrition - methods Female GYNAECOLOGICAL SURGERY (excluding malignant conditions but including complications after surgery) Gynaecology Gynecologic Surgical Procedures Gynecologic Surgical Procedures - adverse effects Humans Intestinal Pseudo-Obstruction Intestinal Pseudo-Obstruction - etiology Length of Stay Medicine General & Introductory Medical Sciences Other POST-OPERATIVE COMPLICATIONS FOLLOWING GYNAECOLOGICAL SURGERY (e.g. urinary retention, thromboembolism) Postoperative Care Postoperative Care - methods Postoperative Complications Postoperative Complications - etiology Postoperative Complications - prevention & control Postoperative Nausea and Vomiting Postoperative Nausea and Vomiting - epidemiology Postoperative Nausea and Vomiting - etiology Randomized Controlled Trials as Topic Surgery Time Factors |
| title | Early versus delayed oral feeding after major gynaecologic surgery |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-15T11%3A59%3A24IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Early%20versus%20delayed%20oral%20feeding%20after%20major%20gynaecologic%20surgery&rft.jtitle=Cochrane%20database%20of%20systematic%20reviews&rft.au=Charoenkwan,%20Kittipat&rft.date=2024-08-12&rft.volume=2024&rft.issue=8&rft.spage=CD004508&rft.pages=CD004508-&rft.issn=1465-1858&rft.eissn=1465-1858&rft_id=info:doi/10.1002/14651858.CD004508.pub5&rft_dat=%3Cproquest_cross%3E3092012110%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3092012110&rft_id=info:pmid/39132743&rfr_iscdi=true |