A PROSPECTIVE CONTROLLED TRIAL OF EARLY POSTOPERATIVE ORAL INTAKE FOLLOWING MAJOR ABDOMINAL GYNECOLOGIC SURGERY

Objective. The objective was to determine whether, when compared with traditional dietary advancement, early oral intake following major gyn ecologic surgery leads to a reduction in the length of hospitalization . Methods. Patients undergoing major abdominal gynecologic surgery wer e invited to participate in this study. After informed consent was obt ained, they were randomized to one of two groups. The control group (g roup 1) was treated traditionally. Oral intake was initiated only afte r documentation of bowel function, which was defined by two of the fol lowing three criteria: (1) bowel sounds; (2) flatus or bowel movement; and (3) subjective hunger. Those assigned to the study group (group 2 ) were given a clear liquid diet on postoperative day 1. Once 500 cc w as tolerated, a regular diet was given. Patients were evaluated on a d aily basis for bowel sounds, flatus, bowel movement, hunger, nausea, v omiting, and need for nasogastric tube decompression. The groups were compared with regard to length of hospital stay, length of postoperati ve ileus, and incidence of adverse effects including nausea, vomiting, and postoperative complications. Statistical analyses were performed with the Student t and chi(2) tests.Results. The demographic character istics of the control (N = 47) and study groups (N = 49) were similar, with no significant differences in underlying medical conditions, pri or abdominal surgery, or diagnosis of a malignancy. The groups did not vary statistically in the number of subjects who required postoperati ve antiemetics or postoperative biscodyl suppository. There was a stat istically significant reduction in the length of hospitalization for t hose patients on the early feeding regimen. The average length of stay for group 1 was 4.02 days +/- 30 (SEM), while that for group 2 was 3. 12 days +/- 0.16 (P = 0.008). While there was a significantly higher i ncidence of emesis in the study population, this was not associated wi th any untoward outcome, and this group actually tolerated a solid die t nearly one full day earlier (2.72 days +/- 0.14 vs 1.88 days a 0.14, P < 0.0001). Conclusions. Early postoperative oral intake results in a decreased length of hospitalization and is well tolerated when compa red with traditional dietary management in patients undergoing abdomin al surgery on a university gynecologic oncology service. (C) 1997 Acad emic Press.