• Kate F Willcutts, Mei C Chung, Cheryl L Erenberg, Kristen L Finn, Bruce D Schirmer, and Laura D Byham-Gray.
• *Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia and Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, NJ†Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA‡George F. Smith Library of the Health Sciences, Rutgers University, Newark, NJ§Department of Nutritional Sciences, Rutgers University, Newark, NJ¶Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia||Department of Nutritional Sciences, Graduate Programs in Clinical Nutrition, Rutgers University, School of Health Professions, Newark, NJ.
• Ann. Surg. 2016 Jul 1; 264 (1): 54-63.

ObjectiveTo compare the effects of early oral feeding to traditional (or late) timing of oral feeding after upper gastrointestinal surgery on clinical outcomes.BackgroundEarly 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.MethodsComprehensive 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.ResultsFifteen 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).ConclusionsEarly 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.

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