1. Heidi Beck & Eva Yuen NUTN 514 February 11, 2008

2. “The ‘progressive diet,’ designed for postoperative feeding and consisting of a clear liquid, then a full liquid, then a regular diet, is based on outmoded concepts. When peristalsis returns after operation, as evidenced by bowel sounds and ability to tolerate water, most patients are able to ingest a regular diet.” Gerard M. Doherty, M.D.

3. Topic Question The effectiveness of early diet advancement vs. ‘traditional feeding protocol’ during the postoperative recovery process. Who? Post-abdominal surgery patients either on early diet advancement or ‘traditional feeding protocol.’ Who? Post-abdominal surgery patients either on early diet advancement or ‘traditional feeding protocol.’ What? The impacts of early diet advancement including liquid diets and solid foods vs. ‘traditional feeding protocol’, where patients remain NPO until bowel motility are documented. What? The impacts of early diet advancement including liquid diets and solid foods vs. ‘traditional feeding protocol’, where patients remain NPO until bowel motility are documented. Where? In-patient care. Where? In-patient care.

4. Analytic Framework a)Early diet advancement b)Traditional feeding a)Early diet advancement b)Traditional feeding Post-abdominal surgical patients Health Outcomes: - Reduced length of hospital stay - Improve patient’s healing process - Early GI functions - Decreased occurrence of postoperative ileus postoperative ileus Health Outcomes: - Reduced length of hospital stay - Improve patient’s healing process - Early GI functions - Decreased occurrence of postoperative ileus postoperative ileus 1 2 3 4 Arrow 1: How are patients with abdominal surgical procedure identified for early diet advancement or traditional feeding protocol? Arrow 2: What are the adverse effects of assessment? Arrow 3: Does early diet advancement reduce length of healing process and hospital stay, promote early GI functions or decrease ileus occurrence while patients are in the hospital? Arrow 4: What are the adverse effects of intervention?

5. PopulationPatients with abdominal surgical procedure Intervention a)Early diet advancement including liquid diet, enteral feeding and solid foods. b)Traditional feeding protocol, which patients remain NPO until bowel motility are documented. Outcomes Measures of length of hospital stay; Occurrence of ileus; GI tract functions including flatus, bowel movements, and bowel sound. Study design Randomized controlled trials or Clinical Control Studies; Case-control studies; Prospective cohort studies; Retrospective studies Sources for searching Medline; Pubmed; EBSCOhost Year range1995-2008 Literature Research Strategy (Inclusion)

6. Animals, cells, or other non-human subjects Non-English language publications No unpublished research, letters, abstract, poster, non- evidence based review Setting (outpatient) Intervention (patients who have postoperative intensive care unit admission; preoperative bowel obstruction.) Sample size <5/ group and <20/study Less than 20% dropout rate Studies that are done prior to year 1995 Abstract Review (Broad Exclusion Criteria)

7. 208 included 267 excluded 475 abstracts Abstract Review

8. Article Review 208 articles from search 211 articles read 3 from outside sources 191 excluded20 studies met inclusion criteria

9. a)Early diet advancement b)Traditional feeding a)Early diet advancement b)Traditional feeding Post-abdominal surgical patients Health Outcomes: - Reduced length of hospital stay - Improve patient’s healing process - Early GI functions - Decreased occurrence of postoperative ileus postoperative ileus Health Outcomes: - Reduced length of hospital stay - Improve patient’s healing process - Early GI functions - Decreased occurrence of postoperative ileus postoperative ileus 1:0 2:0 3:20 4:20 Arrow 1: How are patients with abdominal surgical procedure identified for early diet advancement or traditional feeding protocol? Arrow 2: What are the adverse effects of assessment? Arrow 3: Does early diet advancement reduce length of healing process and hospital stay, promote early GI functions or decrease ileus occurrence while patients are in the hospital? Arrow 4: What are the adverse effects of intervention? Literature Search Yield

10. Bibliographic reference Study type Number of patients Patient characteristics Duration Interventions Measurement methods Outcomes Study quality Quality rating/Comments Evidence Table Construction

11. A randomized controlled trial of early versus "traditional" postoperative oral intake after major abdominal gynecologic surgery. Surgery: Major abdominal gynecologic surgery Number of patients: 107 Intervention: Traditional feeding: NPO  Advanced to solid diet Early feeding: Clear fluids on the 1 st day  Advanced to a regular diet Outcomes: Length of hospital stay Incidence of postoperative complications

12. Early Oral Feeding After Colorectal Resection: A Randomized Controlled Study Surgery: Elective colorectal resection for cancer Number of patients: 100 Intervention: Group A: Patients used a NG tube and was fasting until passage of flatus, followed by liquid diet advanced to soft solid. Group B: Patients had no NG tube and were provided clear liquids the day after surgery, then were followed by soft-solid food. Outcomes: Incidence of complications Resumption of intestinal function and first bowel movement Length of hospital stay

13. Early diet advancement is safe for patients Further research is NEEDED! Our Recommendation

14. Thank You!

15. Questions?