The impact of early postoperative oral intake on the length of hospital stay : a meta-analysis

Abstract

Background: International guidelines regarding the resumption of postoperative intake of liquids are limited. Surgical patients are subjected to unnecessarily prolonged fasting times after surgery, which can lead to increased postoperative complications. Research has shown that a shorter fasting duration can enhance recovery, improve rehabilitation, and reduce the psychological stress associated with major surgeries in these patients. Given these potential benefits, we performed this meta-analysis that aims to explore how the duration of postoperative liquid fasting affects the length of hospital stay. Methods: We systematically searched the literature for papers published in English between 1 January 2010 and 6 January 2023. Meta-analyses were performed using R (version 4.0.2). When means and standard deviations were lacking, these were derived from medians and interquartile ranges if available. For the length of hospital stay (a continuous variable), the standardised mean difference (SMD) and 95% confidence intervals were calculated to summarise the data. We used a random-effects model when high heterogeneity was observed (I2 > 50%). To account for potential causes of heterogeneity, we performed subgroup analyses according to the type of papers (dividing papers into randomised controlled trials and observational studies; and papers with or without mean derivation from medians). Risk of publication bias was checked by drawing funnel plots. Results: A total of nine studies were included. The definition of ‘early feeding’ varied according to the type of procedures included across studies. Shorter postoperative fasting with earlier postoperative intake of liquids was associated with a decrease in the length of hospital stay with a mean difference of 0.9 day (p < 0.05). Results remained similar after sensitivity analysis. Conclusions: Shorter postoperative fasting with earlier postoperative intake of liquids is associated with a decreased length of hospital stay. Future research is needed to explore the relation between postoperative fasting times and length of hospital stay according to the types of surgeries. Editorial Comment: This systematic review confirms that successful early postoperative intake of liquids is associated with post-operative benefit defined as shorter hospital stay. This was shown in the selected non-interventional studies as well as the trial results, where all the individual study findings for the chosen outcome were in the same direction.