Ultra-early postoperative feeding and its impact on reducing endovenous fluids

1 Universidade Federal do Mato Grosso, Hospital Universitário Júlio Müller Cuiabá MT Brasil. 2 Universidade de Cuiabá, Faculdade de Medicina Cuiabá MT Brasil. 3 Centro Universitário de Várzea Grande, Faculdade de Medicina Várzea Grande MT Brasil. Franco Ultra-early postoperative feeding and its impact on reducing endovenous fluids. 2 Rev Col Bras Cir 47:e20202356 To date, no authors have specifically evaluated patients undergoing this protocol. Empirically, the majority of patients undergoing “ultra-early” feeding do not need any type of parenteral fluid therapy in the postoperative period. They will be able to orally reach their water requirements, as soon as they are discharged from the post-anesthetic recovery unit. However, the proof of concept of this hypothesis has not yet been demonstrated. Based on this, the present study aims to investigate the use of “ultra-early” postoperative feeding (oral liquids offered in the post-anesthetic recovery) in patients undergoing common general operations, and to evaluate the volume of intravenous fluids, as well as the occurrence of complications and length of hospital stay.

Original Article Ultra-early postoperative feeding and its impact on reducing endovenous fluids.

Uso da realimentação pós-operatória ultra precoce e seu impacto na redução de fluidos endovenosos.
Franco Ultra-early postoperative feeding and its impact on reducing endovenous fluids. To date, no authors have specifically evaluated patients undergoing this protocol.
Empirically, the majority of patients undergoing "ultra-early" feeding do not need any type of parenteral fluid therapy in the postoperative period. They will be able to orally reach their water requirements, as soon as they are discharged from the post-anesthetic recovery unit. However, the proof of concept of this hypothesis has not yet been demonstrated. Based on this, the present study aims to investigate the use of "ultra-early"

RESULT(S)
A total of 154 consecutive patients were analyzed, and the operative procedures they underwent are described in Table 1.  Figure 1, patients for whom the "ultra-early" feeding was not allowed, oral diets were offered later -a median of 6h (range from 3 to 24h) after discharge from the PAR unit (p <0.001), and they were allowed solid diets in 27.2%, soft diet in 54.5% and liquids in 18.1%. There was no difference in the percentage of complications between patients who received or did not receive the "ultra-early" feeding (p = 0.291). Vomiting in the postoperative period was seen in 11% (17) of the patients. 11.1% of the patients in the "ultra-early" feeding vomited while 10% of patients without the "ultra-early" feeding did not (with no statistically significant difference between groups (p = 0.696)). There were 10 cases of surgical infections, which corresponds to 6.5% of the total operated patients. Most of these infection cases were related to ventral hernias operations (30%). Only one surgical-site infection (SSI) was diagnosed during the hospital stay (this was also the most severe case, requiring the patient to remain in the hospital for fifteen days), the others (90% of SSI cases), were diagnosed and resolved in the outpatient clinic. There were no cases of readmissions. There were no differences between patients who underwent the "ultraearly" feeding with those who did not follow such protocol, regarding complications (p = 0.5345) Figure 2. Volume of venous hydration with crystalloids received in the postoperative period, stratified by patients who received or not "ultra-early" feeding (* p = 0.018).

Figure 1. Time (in hours) for the first meal after discharge from PAR unit (ward feeding) in patients who had been fed in PAR and in those where this was not done (* p <0.001).
Rev Col Bras Cir 47:e20202356

DISCUSSION
The present study demonstrates that patients undergoing common general surgical procedures, who follow the ACERTO multimodal protocol and who were treated by the "ultra- to 40%, reaching up to 80% in high-risk patients 15 .
This reinforces the benefits of the multimodal protocol associated with the "ultra-early" feeding and decreased intravenous hydration.
In this study, we found 6.5% (10 cases It is important to highlight that this is an observational study which may impact results, in particular, since the adherence to the "ultraearly" postoperative feeding protocol was high (93.5%). Thus, in order to better assess the impact of this protocol, especially in terms of postoperative morbidity, it is important to carry out further studies, with a more homogeneous sample and an equal number of cases among the groups. when we talk about strategies to improve surgical recovery in its various perspectives. The "ultraearly" feeding and the consequent decrease in the volume of intravenous fluids seem to be a simple, safe and potentially cost-effective approach. This is still a non-routine protocol in most services in Brazil.

CONCLUSION
The "ultra-early" postoperative feeding was feasible in a group of patients undergoing common general surgical procedures. Patients undergoing this protocol received minimal volumes of postoperative intravenous fluids, which was significantly lower than those who were fed on a routine protocol. The "ultra-early" feeding patients