Early oral feeding as compared with traditional timing of oral feeding after upper gastrointestinal surgery

Objective: To compare the effects of early oral feeding to traditional (or late) timing of oral feeding after upper gastrointestinal surgery on clinical outcomes. Background: Early postoperative oral feeding is becoming more common, particularly as part of multimodal or fast-track protocols. However, concerns remain about the safety of early oral feeding after upper gastrointestinal surgery. Methods: Comprehensive literature searches were conducted across 5 databases from January 1980 until June 2015 without language restriction. Risk of bias of included studies was appraised and random-effects model meta-analyses were performed to synthesize outcomes of anastomotic leaks, pneumonia, nasogastric tube reinsertion, reoperation, readmissions, and mortality. Results: Fifteen studies comprising 2112 adult patients met all the inclusion criteria. Mean hospital stay was significantly shorter in the early-fed group than in the late-fed group [weighted mean difference=-1.72 d, 95% confidence interval (CI) -1.25 to -2.20, P < 0.01). Postoperative length of stay was also significantly shorter (weighted mean difference=-1.44 d, 95% CI -0.68 to -2.20, P < 0.01). There was no significant difference in risk of anastomotic leak, pneumonia, nasogastric tube reinsertion, reoperation, readmission, or mortality in the randomized controlled trials (RCTs). The pooled RCT and non-RCT results, however, showed a significantly lower risk of pneumonia in early-fed as compared with late-fed group (odds ratio = 0.6, 95% CI 0.41-0.89, P = 0.01). Conclusions: Early postoperative oral feeding as compared with traditional (or late) timing is associated with shorter hospital length of stay and is not associated with an increase in clinically relevant complications.