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Early versus delayed oral fluids and food for reducing complications after major abdominal gynaecologic surgery

  • Review
  • Intervention

Authors


Abstract

Background

Traditionally postoperative oral intake is withheld until the return of bowel function. There has been concern that early oral intake would result in vomiting and severe paralytic ileus with subsequent aspiration pneumonia, wound dehiscence, and anastomotic leakage. However, supporting scientific evidence for this traditional practice is lacking and there are potential benefits from early postoperative oral intake.

Objectives

To assess the effects of early versus delayed (traditional) initiation of oral intake of food and fluids after major abdominal gynaecologic surgery.

Search methods

We searched the Menstrual Disorders & Subfertility Group's Specialised Register of controlled trials, the electronic databases (MEDLINE, EMBASE, CINAHL), the Cochrane Controlled Trials Register, and the citation lists of relevant publications in April 2007.

Selection criteria

Randomised controlled trials that compared the effect of early versus delayed initiation of oral intake of food and fluids after major abdominal gynaecologic surgery were considered. Early feeding was defined as having oral intake of fluids or food within the first 24 hours after surgery regardless of the presence or absence of the signs that indicate the return of bowel function and delayed feeding was defined after first 24 hours following surgery and only after clinical signs of resolution of postoperative ileus.

Data collection and analysis

Studies considered were assessed for methodological quality criteria for inclusion. For dichotomous data, relative risks and 95% confidence intervals were calculated. Continuous data were examined using weighted mean difference and 95% confidence interval. Heterogeneity between the results of different studies were examined by using the forest plot of a meta-analysis, the statistical tests of homogeneity of 2 x 2 tables and the I2 value.

Main results

Early commencement of oral fluids and food was associated with: increased nausea (one study, 195 patients; relative risk 1.79, 95% confidence interval 1.19 to 2.71), shorter time to the presence of bowel sound (one study, 195 patients; weighted mean difference -0.5 day, 95% confidence interval -0.84 to -0.16), shorter time to first solid diet (two studies, 301 patients; weighted mean difference -1.47 day, 95% confidence interval -2.26 to -0.68), and a trend toward shorter hospital stay (two studies, 301 patients; weighted mean difference -0.73 day, 95% confidence interval -1.52 to 0.07). The shorter hospital stay with early feeding was also evident in the study that reported length of hospital stay in median (-2 days, 4.0 days in early feeding group and 6.0 days in traditional feeding group).

There was no significant difference in postoperative ileus, vomiting, and abdominal distension, time to presence of flatus, time to the first passage of stool, postoperative nasogastric tube placement, febrile morbidity, wound complications, and pneumonia.

Authors' conclusions

Early feeding after major abdominal gynaecologic surgery is safe however associated with the increased risk of nausea and a reduced length of hospital stay. Whether to adopt the early feeding approach should be individualised. Further studies should focus on the cost-effectiveness, patient's satisfaction, and other physiological changes.

摘要

背景

早期與延遲 (傳統) 進食對於減低經腹部重大婦科手術併發症的比較

傳統上,術後病人會等到腸胃道功能恢復後再開始進食,因為擔心早期進食可能會造成嘔吐或嚴重的麻痺性腸阻塞而進ㄧ步發展成吸入性肺炎,傷口爆裂,和接口處滲漏。但是,並沒有科學的證據顯示傳統的觀念是正確的。除此之外,術後早期進食可能會有一些好處。

目標

比較經腹部重大婦科手術後早期進食或延遲 (傳統) 進食的影響。

搜尋策略

本篇搜尋了登記在 Menstrual Disorders and Subfertility Group Specialised Register 內的試驗, 電子資料庫 (MEDLINE, EMBASE, CINAHL), the Cochrane Controlled Trials Register 以及其他在2007年4月發表的相關文章及引用的文獻資料。

選擇標準

納入比較經腹部重大婦科手術後早期進食與延遲進食的隨機對照試驗 (Randomised controlled trials) 。所謂早期進食的定義是在手術後24小時內即進食 (液體或固體食物) ,無論有無腸道已經恢復的證據。所謂延遲進食是在術後24小時後,在有臨床證據顯示術後腸麻痺已經恢復後才開始進食。

資料收集與分析

所有的研究在納入前皆接受方法學品質的審核。針對二分數據計算出相對風險及95% 信賴區。連續的數據則用加權平均差及95% 信賴區檢視。不同研究之間結果的差異性以統合分析的forest plot,2 X 2表格一致性與I2值之統計計算來加以檢視

主要結論

早期進食與以下相關:增加反胃的感覺 (−個研究,共195位病患; 相對風險1.79, 95% confidence interval 1.19 to 2.71), 較短腸音出現的時間 ((−個研究,共195位病患; weighted mean difference −0.5 day, 95% confidence interval −0.84 to −0.16) 較短從禁食到固體食物的時間 (兩個研究,301位病患; weighted mean difference −1.47 day, 95% confidence interval −2.26 to −0.68) ,較短住院天數的趨勢 (兩個研究,301位病患; weighted mean difference −0.73 day, 95% confidence interval −1.52 to 0.07) 。 早期進食與較短住院天數的關係亦在一研究的住院天數中數可看出 (少2天,早期進食者4天,延遲進食者6天). 對於以下則無有意義的差別:手術後腸阻塞,嘔吐及腹脹,恢復排氣的時間,恢復排便的時間,術後鼻胃管的置放,發燒,傷口的併發症,以及肺炎。

作者結論

在重大經腹部婦科手術後早期進食是安全的,但可能會稍微提高反胃的機會,也可以減低住院的天數。是否採納早期進食的方法應該是因人而異。未來的研究應著重於成本效益,病人的滿意度及其他的生理變化。

翻譯人

本摘要由高雄醫學大學附設醫院張慧名翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

在重大經腹部婦科手術的一天內,病患可以安全的開始進食。這種作法可能會稍微提高反胃的機會,但是卻可以減低住院的天數。

Plain language summary

Early versus delayed oral fluids and food for reducing complications after major abdominal gynaecologic surgery

On the first day after major gynaecological surgery women may safely start drinking and eating. This practice slightly increases the chance of having nausea but could reduce the length of hospital stay.

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