Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 953-964
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.953
Nutritional status efficacy of early nutritional support in gastrointestinal care: A systematic review and meta-analysis
Li-Bin He, Ming-Yuan Liu, Yue He, Ai-Lin Guo
Li-Bin He, Department of Anesthesia and Surgery, Xiang'an Hospital Affiliated to Xiamen University, Xiamen 361100, Fujian Province, China
Ming-Yuan Liu, Department of Endocrine, Xiang'an Hospital, Xiamen University, Xiamen 361100, Fujian Province, China
Yue He, Department of Rheumatology and Immunology, Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Ai-Lin Guo, Department of Cardiac Surgery, Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361100, Fujian Province, China
Author contributions: He LB and Liu MY contributed equally to this study; He LB designed this study; He LB and He Y analyzed the data; Guo AL wrote manuscript; and all authors read and approved the final manuscript.
Conflict-of-interest statement: No conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ai-Lin Guo, RN, Master's Student, Department of Cardiac Surgery, Hospital of Xiamen University, School of Medicine, Xiamen University, Xiang'an South Road, Xiang'an District, Xiamen 361100, Fujian Province, China. 408693301@qq.com
Received: January 12, 2023
Peer-review started: January 12, 2023
First decision: February 10, 2023
Revised: February 20, 2023
Accepted: March 31, 2023
Article in press: March 31, 2023
Published online: May 27, 2023
Abstract
BACKGROUND

Gastrointestinal surgery is a complicated process used to treat many gastrointestinal diseases, and it is associated with a large trauma: Most patients often have different degrees of malnutrition and immune dysfunction before surgery and are prone to various infectious complications during postoperative recovery, thus affecting the efficacy of surgical treatment. Therefore, early postoperative nutritional support can provide essential nutritional supply, restore the intestinal barrier and reduce complication occurrence. However, different studies have shown different conclusions.

AIM

To assess whether early postoperative nutritional support can improve the nutritional status of patients based on literature search and meta-analysis.

METHODS

Articles comparing the effect of early nutritional support and delayed nutritional support were retrieved from PubMed, EMBASE, Springer Link, Ovid, China National Knowledge Infrastructure, China Biology Medicine databases. Notably, only randomized controlled trial articles were retrieved from the databases (from establishment date to October 2022). The risk of bias of the included articles was determined using Cochrane Risk of Bias V2.0. The outcome indicators, such as albumin, prealbumin, and total protein, after statistical intervention were combined.

RESULTS

Fourteen literatures with 2145 adult patients undergoing gastrointestinal surgery (1138 patients (53.1%) receiving early postoperative nutritional support and 1007 patients (46.9%) receiving traditional nutritional support or delayed nutritional support) were included in this study. Seven of the 14 studies assessed early enteral nutrition while the other seven studies assessed early oral feeding. Furthermore, six literatures had "some risk of bias," and eight literatures had "low risk". The overall quality of the included studies was good. Meta-analysis showed that patients receiving early nutritional support had slightly higher serum albumin levels, than patients receiving delayed nutritional support [MD (mean difference) = 3.51, 95%CI: -0.05 to 7.07, Z = 1.93, P = 0.05]. Also, patients receiving early nutritional support had shorter hospital stay (MD = -2.29, 95%CI: -2.89 to -1.69), Z = -7.46, P < 0.0001) shorter first defecation time (MD = -1.00, 95%CI: -1.37 to -0.64), Z = -5.42, P < 0.0001), and fewer complications (Odd ratio = 0.61, 95%CI: 0.50 to 0.76, Z = -4.52, P < 0.0001) than patients receiving delayed nutritional support.

CONCLUSION

Early enteral nutritional support can slightly shorten the defecation time and overall hospital stay, reduce complication incidence, and accelerate the rehabilitation process of patients undergoing gastrointestinal surgery.

Keywords: Early nutritional support, Gastrointestinal care, Nutritional status, Gastrointestinal surgery, Gastrointestinal diseases

Core Tip: Gastrointestinal tract surgery is a complex process, with a wide range of operations and large trauma. It is easy to have various infectious complications in postoperative recovery, which affects the efficacy of surgical treatment. Early postoperative nutritional support can provide necessary nutrition, restore intestinal barrier, and reduce complications. However, whether early postoperative nutritional support can significantly improve the nutritional status of patients, different studies have reached different conclusions. This study used literature retrieval and Meta analysis to conduct quantitative analysis. It was found that early enteral nutrition support could shorten the defecation time after gastrointestinal surgery, the overall hospital stay, reduce the incidence of complications, and speed up the rehabilitation process. However, the improvement of nutritional status was not significant.