Introduction Oesophagectomy is associated with pre- and postoperative nutritional difficulties, including protein-energy malnutrition (defined as >10% weight loss). Postoperative nutritional enhanced recovery aims to optimise nutrition with early reintroduction of enteral feeding by post-pyloric feeding (jejunostomy) following their operation, and also a period of overnight enteral feeding following discharge for the patients at greatest risk of failure to thrive.
Method To investigate the postoperative weight changes and readmissions in patients who continued PPF after discharge and those who did not receive prolonged feeding, this retrospective audit reviewed case notes for 210 patients who underwent oesophagectomy between 1stJanuary 2012 and 30thApril 2014. Analyses were performed in SPSS v17.0 as Kruskal-Wallis and post-hoc Mann Whitney with Holm’s correction, statistical significance defined as p < 0.05.
Results Thirty-seven patients continued post-pyloric feeding following discharge for a median duration of 78 days. They had a significantly lower preoperative BMI (24.6 vs. 26.0, p = 0.016), but no significant difference in age, gender or postoperative length of stay. Until 6-months postoperatively, those who received prolonged PPF had significantly lower weight loss (-8.0% vs. 12.8%, p < 0.001), however following the cessation of feeding, their weight loss rapidly increased to be non-significantly different to the non-feeding group at 12-months (–11.2% vs. 12.6%, p = 0.364). The non-feeding group had a greater proportion of patients at all follow-up stages who had a weight loss >10%. There was no significant difference in overall readmissions, however there were significantly fewer patients readmitted with failure to thrive in the PPF group (p = 0.021).
Conclusion Oesophagectomy is shown to be associated with substantial weight loss and postoperative protein-energy malnutrition. Postoperative weight loss and failure to thrive can be significantly reduced with post-pyloric feeding following discharge. This audit supports implementation of prolonged PPF in patients at risk of failure to thrive.
Disclosure of interest None Declared.