Enhancing recovery in non-critical care emergency bowel resection

Introduction: The aim of this study was to investigate the feasibility and safety of an enhanced recovery approach incorporating avoidance of routine post-operative nasogastric (NG) decompression and early oral fluids and diet when compared to traditional care in non-critical care (Level 0/1) patients following emergency bowel resection. Method: A single centre comparative observational study was used to compare outcomes between two existing parallel groups of Level 0/1 emergency bowel resection patients. Strict inclusion criteria governed eligibility. Groups were differentiated according to presence (Traditional care, TRAD) or absence (Enhanced care, ERP) of NG tube at the end of surgery. The primary study outcome was toleration of oral fluid and diet. Secondary outcomes were post-operative complications and length of hospital stay. Study endpoints were inpatient discharge home, transfer to another speciality, death, insertion/re- insertion of NG tube and re-operation. Results: Between October 2013 and February 2015, 61 patients (27 ERP, 34 TRAD) met the eligibility criteria. Study groups were comparable. On average, the ERP group tolerated oral fluids (p=0.001) and oral diet (p=0.019) significantly earlier than the TRAD group. No statistically significant differences were found between groups in incidence of post-operative complication (p=0.589), length of hospital stay (p=0.189) or study endpoints (p=0.386) Conclusion: An enhanced care approach incorporating avoidance of routine NG decompression and re-introduction of early oral fluid and diet is tolerated in Level 0/1 emergency bowel resection patients with no significant difference in post-operative complication or length of hospital stay when compared to traditional care. This supports the feasibility and safety of an enhanced care approach in this patient group although further research is required in relation to those with intra-operative ischaemia.