Early Enteral Nutrition Reduced Postoperative Ileus And Improved The Outcomes In Patients With Emergency Intestinal Surgery: Results From A Propensity Score Analysis

Background: Enteral nutrition (EN), especially early enteral nutrition (EEN), could effectively increase the blood flow of gut mucosa, stimulate the intestinal motility, maintain the gut integrity, decrease the incidence of infectious complications, ameliorate patient's outcome after surgery. Thus, the aim of this study was to investigate the effect of EEN in patients with nontraumatic or traumatic intestinal strangulation or perforation after emergency surgery. Methods: From January 2005 to December 2016, patients underwent emergency intestinal surgery were selected. Patients with bowel resection and/or anastomosis or primary repair with traumatic or nontraumatic intestinal perforation were all included in this retrospective study. 603 patients who either received early EN (n=101) or received late EN (N=502) was analyzed. Results: Matching of patients according to propensity score resulted in a cohort that consisted of 86patients in the EEN group and of 86 patients in the late EN group. Compared with patients in the late EN group, patients receiving EEN had reduced the time of first defecation (P=0.02), early ileus rates (P=0.04), total patients with complications (P=0.03), lengths of hospital stay (P<0.01), in hospital mortality rates (P=0.03), and lengths of ICU stay (P=0.046). Furthermore, CRP decrease was more pronounced on postoperative day 5 in the EEN group compared with the late EN group (P<0.01). The multivariate analysis with Cox regression analysis suggested that EEN was an independent risk factor for the overall survival (P=0.011). Conclusions: EEN therapy in patients with emergency intestinal surgery significantly reduced total patients with complications, early ileus, time to first defecation, length of hospital stay, mortality and increased 28-day ICU-free days.