Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.953
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
Gastrointestinal surgery is a complicated process used to treat many gastro
To assess whether early postoperative nutritional support can improve the nutritional status of patients based on literature search and meta-analysis.
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.
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.
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.
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.