Patterns of postoperative feeding and their association with In-hospital outcomes among emergency laparotomy patients in MNRH: A prospective cohort study

Abstract

Background: Emergency laparotomy in sub-Saharan Africa is a common place procedure with relatively poorer outcomes of surgery compared to Elective laparotomy. Mortality following emergency abdominal surgery in low-income countries has been found to be three times that of high-income countries (Bhangu et al., 2016) . Perioperative nutrition contributes to the outcomes of surgery. Objective: To determine the patterns of oral post-operative feeding among patients following emergency laparotomy as well as the association between the feeding patterns and the inhospital outcomes after surgery. Methods: This was a prospective cohort study in Mulago national referral hospital carried out between May 2023 and September 2023. Patients who underwent emergency laparotomy and were initiated on oral feeding were recruited and followed for a maximum for 30 days. An interviewer administered questionnaire was used to collect data on feeding patterns, length of hospital stay, passage of flatus and gut leakage. Data was cleaned and analysed using STATA version 16. Mann-whittney U-test was used to compare length of hospital stay between early and late feeding, modified poisson regression was used to estimate the association of independent factors with late passage of flatus whereas linear regression was used to estimate the relationship between length of hospital stay with the independent factors. Results: Of the 125 participants, 91 were male and 34 were female, median age of 28 years. 72.8% of the participants started feeds late. 41% of the participants advanced to solid feeds within 24 hours of initiating feeds. The mean length of hospital stay between early and late feeding were 5 days and 9 days respectively (p=0.000). Factors associated with increased length of hospital stay were; Late feeding (b coefficient=0.12(0.04-0.28), p=0.015), positive HIV status (b coefficient =0.17(0.4-0.49), p=0.011) and duration of use of NGT (p=0.001). Early initiation of feeding was associated with reduced risk of delayed passage of flatus (aRR 0.91, 95%CI 0.59-1.42, P-value 0.683. The other factors associated with reduced risk of late passage of flatus were; type of surgery (aRR 0.92, 95% CI 0.72-1.19, p-value 0.558 for laparotomy without bowel surgery and aRR 0.81, 95% CI 0.62-1.06, p-value 0.124 for perforation repair). The delayed timing of ambulation was associated with increased risk of late passage of flatus (aRR 1.99, 95% CI 1.21-3.25, p-value 0.006, aRR 2.29, 95% CI 1.38- 3.78, p-value 0.001 and aRR 2.86, 95% CI 1.93-3.69, p value 0.002 for 1st, 2nd and 3rd postoperative days respectively. Conclusion and recommendations: Patients who initiate oral feeding within 24 hours after emergency laparotomy (early feeding) have a shorter length of hospital stay and early passage of flatus compared to those with late feeding. The other independent factors that predict longer hospital stay were positive HIV status and longer period of nasogastric usage. Delayed ambulation post-operatively predisposes to delayed passage of flatus Early feeding is beneficial and should be encouraged when indicated