Level 2: Mid-level evidence

For the treatment of colonic ileus, delaying feeding until after return of bowel function does not appear necessary. Based on a Cochrane review with limited evidence, early feeding after GI surgery may actually reduce mortality and length of hospital stay (Cochrane Database Syst Rev. 2006[4]:CD004080). The systematic review included 13 randomized trials comparing early enteral feeding within 24 hours vs. no feeding in 1,173 patients following GI surgery. Early enteral feeding was defined as any oral intake or any tube feeding with caloric content; no feeding was defined as no caloric oral intake and no tube feeding before return of bowel function.

Mortality rates favored early feeding (1.3% vs. 3.7%, P =.03, NNT 42), based on 10 trials with 907 patients. The most commonly reported causes of death were anastomotic leakage, reoperation, and acute MI. However, the reviewers believe that the difference in mortality is due to chance and do not consider these causes related to enteral feeding. Early feeding was associated with increased vomiting (33.8% vs. 26.5%, P =.04, NNH 13), based on six trials with 618 patients. Early feeding was also associated with reduced length of hospital stay, by weighted mean difference of 0.89 days, based on 13 trials with 1,081 patients. There were no significant differences in rates of wound infection, intra-abdominal abscess, anastomotic leakage or dehiscence, or pneumonia.

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Based on another previously published systematic review with limited evidence (J Clin Nurs. 2006;15:696-709), early oral feeding appears safe and may shorten postoperative ileus. Fifteen studies of early oral feeding (allowing fluids and food before bowel function returned) in 1,352 adults following elective open colorectal surgery were included. Five of the randomized trials were criticized for lack of blinding and inadequate randomization. Eighty-six percent of patients (range 73%-100%) tolerated early feeding, and all of the studies concluded that early oral feeding was safe. The total complication rate was 12.5% (range 0%-15%) in 935 early-feeding patients; there was no increased risk of anastomotic leakage, aspiration pneumonia, or bowel obstruction. Reduced length of ileus and shorter hospital stay were associated with multimodal approaches that included early feeding.