Clinical Decisionmaking

Early postoperative enteral feeding for bowel resection patients is cost effective

Starting patients on early postoperative enteral feeding following surgical resection of the small or large intestine is cost effective, finds a study supported in part by the Agency for Health Care Policy and Research (HS08440). Sixty-six patients were fed by a jejunal feeding tube (tube inserted into the small intestine during surgery) within 12 hours after surgery compared with 159 control patients who were fed within the first 5 days after surgery (usual care). A dietitian monitored the nutritional status of the treatment patients on a daily basis. Anne-Marie Hedberg, Dr.P.H., M.S., R.D., of the University of Texas School of Public Health and the Houston Health Science Center, and her colleagues compared the outcomes and cost of care for both groups, who were treated at the Texas Medical Center for similar diagnoses and subsequent bowel resections during an 18-month period.

An average of $1,531 was saved per successful treatment patient, which more than offset the additional cost of $108.30 for the dietitian's time. Overall, early tube feeding resulted in $4,450 total cost savings per success in the treatment group. Also, 91 percent of treatment patients had no infection compared with 83 percent of control patients, probably due to the shorter average time (1.8 vs. 5.8 days) that treatment patients spent on total parenteral nutrition (TPN).

Early jejunal feeding was considered a replacement for TPN, which requires placement of a central line into one of the large veins returning blood to the heart for intravenous feeding. The associated risk of bloodstream infections in patients with central venous catheters (CVC) is substantial. Thus, reducing the number of days patients must have these CVCs for TPN is desirable. In addition, 100 percent of treatment patients versus only 1.7 percent of control patients were receiving nasogastric tube feedings by postoperative day 3. The researchers recommend creating a jejunal feeding access for surgical patients if it is likely that diet may not be initiated in the first few days after surgery.

More details are in "Economic implications of an early postoperative enteral feeding protocol," by Dr. Hedberg, David R. Lairson, Ph.D., Lu Ann Aday, Ph.D., and others, in the July 1999 Journal of the American Dietetic Association 99(7), pp. 802-807.

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