Effect of early oral feeding within 24 hours compared to standard oral feeding in peptic ulcer and proximal small bowel perforation, A non-randomized controlled trial
Keywords:
peptic ulcer perforation, proximal small bowel, perforation , feeding, postoperative recoveryAbstract
Objectives: This study aims to compare the outcomes of postoperative early oral feeding within 24 hours following surgery for peptic ulcer and proximal small bowel perforation between patients who started oral feeding within 24 hours and those who followed the standard practice of oral feeding. The study evaluates the impact on reducing hospital length of stay, complications, nasogastric tube retention, urine catheter retention, mortality, and readmission within 30 days after surgery.
Methods: This non-randomized controlled trial was conducted on patients who underwent surgery for peptic ulcer and proximal small bowel perforation at Nakhonping Hospital between August 2020 and August 2021. The study compared a group of patients who started oral feeding within 24 hours (early feeding group) with a group of patients who followed the standard practice of starting oral feeding after 24 hours (standard group). The sample size was stratified according to the operating surgeon. Data analysis included descriptive statistics, Fisher's exact test, and independent t-test to compare differences. Multivariable linear regression was used to adjust for confounding variables.
Results: A total of 26 patients with peptic ulcer and proximal small bowel perforation participated in the study, with 17 patients (65.4%) in the group that started oral feeding within 24 hours and 9 patients (34.6%) in the standard oral feeding group. Baseline characteristics such as gender, age, body mass index, and comorbidities did not significantly differ between the two groups. The group that started oral feeding within 24 hours had a significantly shorter average hospital length of stay (3.39 ± 0.76 days) compared to the standard oral feeding group (6.04 ± 1.56 days), p-value < 0.001. One patient in the early feeding group experienced complications such as postoperative complications, repeated nasogastric tube insertion, and surgical site infections. There were no cases of hospital readmission or mortality within 30 days in either group. Multivariable linear regression analysis, adjusted for post-operative drainage, showed that early feeding group after surgery for peptic ulcer and proximal small bowel perforation could significantly reduce hospital length of stay by -2.04 days (95% CI -3.00, -1.08), p-value < 0.001.
Conclusion: Initiating early postoperative oral feeding within 24 hours after surgery for peptic ulcer and proximal small bowel perforation can lead to a reduction in hospital length of stay. Further studies should be conducted to explore the safety and potential complications before implementing this practice.
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