heidi beck & eva yuen nutn 514 february 11, 2008

Heidi Beck & Eva YuenHeidi Beck & Eva YuenNUTN 514NUTN 514

February 11, 2008February 11, 2008

“The ‘progressive diet,’ designed for postoperative feeding and consisting of a clear liquid, then a full liquid, then a regular diet, is based on outmoded concepts. When peristalsis returns after operation, as evidenced by bowel sounds and ability to tolerate water, most patients are able to ingest a regular diet.”

Gerard M. Doherty, M.D.

Topic QuestionTopic QuestionThe effectiveness of early diet advancement vs. ‘traditional feeding protocol’ during the postoperative recovery process.

Who? Post-abdominal surgery

patients either on early diet advancement or ‘traditional

feeding protocol.’

What? The impacts of early diet advancement including liquid diets and solid foods vs. ‘traditional feeding protocol’, where patients remain NPO until bowel

motility are documented.

Where? In-patient care.

Analytic FrameworkAnalytic Framework

a)a) Early diet Early diet advancementadvancement

b)b) Traditional Traditional feedingfeeding



Post-abdominal Post-abdominal surgical surgical patientspatients


Health Outcomes:Health Outcomes:- Reduced length of hospital stayReduced length of hospital stay- Improve patient’s healing processImprove patient’s healing process- Early GI functionsEarly GI functions- Decreased occurrence of Decreased occurrence of postoperative ileuspostoperative ileus


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Arrow 1: How are patients with abdominal surgical procedure identified for early diet advancement or traditional feeding protocol?Arrow 2: What are the adverse effects of assessment? Arrow 3: Does early diet advancement reduce length of healing process and hospital stay, promote early GI functions or decrease ileus occurrence while patients are in the hospital?Arrow 4: What are the adverse effects of intervention?

Population Patients with abdominal surgical procedure

Intervention

a) Early diet advancement including liquid diet, enteral feeding and solid foods.

b) Traditional feeding protocol, which patients remain NPO until bowel motility are

documented.

OutcomesMeasures of length of hospital stay; Occurrence of ileus;GI tract functions including flatus, bowel movements, and bowel sound.

Study design

Randomized controlled trials or Clinical Control Studies;Case-control studies;Prospective cohort studies;Retrospective studies

Sources for searching

Medline; Pubmed; EBSCOhost

Year range 1995-2008

Literature Research Strategy (Inclusion)Literature Research Strategy (Inclusion)

Animals, cells, or other non-human subjectsNon-English language publicationsNo unpublished research, letters, abstract, poster,

non-evidence based reviewSetting (outpatient)Intervention (patients who have postoperative

intensive care unit admission; preoperative bowel obstruction.)

Sample size <5/ group and <20/studyLess than 20% dropout rate Studies that are done prior to year 1995

Abstract Review Abstract Review (Broad Exclusion Criteria)(Broad Exclusion Criteria)

Abstract Review Abstract Review

Article Review Article Review 208 articles from search

211 articles read

3 from outside sources

191 excluded 20 studies met inclusion criteria









1:01:0

2:02:0

3:203:20

4:204:20

Arrow 1: How are patients with abdominal surgical procedure identified for early diet advancement or traditional feeding protocol?Arrow 2: What are the adverse effects of assessment? Arrow 3: Does early diet advancement reduce length of healing process and hospital stay, promote early GI functions or decrease ileus occurrence while patients are in the hospital?Arrow 4: What are the adverse effects of intervention?

Literature Search YieldLiterature Search Yield

Bibliographic referenceStudy typeNumber of patientsPatient characteristicsDurationInterventionsMeasurement methodsOutcomesStudy qualityQuality rating/Comments

Evidence Table ConstructionEvidence Table Construction

A randomized controlled trial of early versus A randomized controlled trial of early versus "traditional" postoperative oral intake after major "traditional" postoperative oral intake after major abdominal gynecologic surgery.abdominal gynecologic surgery.

Surgery: Major abdominal gynecologic surgery

Number of patients: 107Intervention:

Traditional feeding: NPO Advanced to solid dietEarly feeding: Clear fluids on the 1st day Advanced to a

regular diet

Outcomes:Length of hospital stayIncidence of postoperative complications

Early Oral Feeding After Colorectal Resection: Early Oral Feeding After Colorectal Resection: A Randomized Controlled StudyA Randomized Controlled StudySurgery: Elective colorectal resection for cancerNumber of patients: 100Intervention:

Group A: Patients used a NG tube and was fasting until passage of flatus, followed by liquid diet advanced to soft solid.

Group B: Patients had no NG tube and were provided clear liquids the day after surgery, then were followed by soft-solid food.

Outcomes: Incidence of complicationsResumption of intestinal function and first bowel movementLength of hospital stay

Early diet advancement is safe for patientsFurther research is NEEDED!

Our RecommendationOur Recommendation

Thank You!

Questions?