Protocolo simplificado de recuperação pós-operatória em pacientes submetidos a colectomias eletivas: estudo prospectivo randomizado

Abstract

The benefits of early feeding after abdominal operations have been known since 1979. It is known that the introduction of the diet, both enterally and orally, before the end of postoperative ileus, in patients undergoing gastrointestinal surgery promotes better metabolic recovery and reduces hospital stay. To maximize postoperative recovery specific protocols known as fast track have been described. The main goals of such protocols are the attenuation of the organic response to surgical stress, thus leading to accelerated recovery, decreased complications and, hospital stay. Despite substantial evidence on this kind of benefits, mainly on colorectal surgery, slow changes in surgical practice have been described. Among the reasons raised, the difficulty in implementing complex protocols have been pointed out. The aim of this prospective randomized study was to evaluate the safety and benefits of a simplified program of postoperative rehabilitation after elective colectomy, mainly focused on early oral feeding. The hypothesis was that this current protocol could reduce the length of hospital stay without increasing complication and readmission rates, and with good tolerance to early oral diet. Fifty-eight patients admitted for elective colonic surgery were prospectively randomized into two groups: An early feeding group (EFG) on the first postoperative day (POD), patients initially received an oral liquid diet and were advanced to a regular diet within the next 24 hours as tolerated and at their discretion; a traditional care group (TCG) patients were managed by nothing per orus until the elimination of the first flatus and then received an oral liquid diet, followed by a regular diet within the next 24 hours as described for the EFG. All patients followed a well-defined, simplified rehabilitation program. Patients baseline characteristics were similar in the two groups except for the duration of surgery. Hospital stay was significantly lower in the EFG (median of 3 days (3-21) versus 4 days (3-33); p=0.000). Diet tolerance and progression were similar between groups. Time to first flatus after surgery was significantly lower in the EFG (2 days (1-2) versus 2 days (1-4); p=0.019). Complication and readmission rates were similar in both groups. Early oral nutrition associated with a simplified, well-defined perioperative rehabilitation program reduces postoperative ileus time and length of hospital stay after elective colonic resection without increasing rates of complications or readmissions.