Date of Degree

12-2018

Document Type

Thesis

Degree Name

Master of Science (MS)

Program

Nutrition

Advisor

Beth Senne-Duff

Advisor

Joseph Bonilla

Advisor

Laura Munoz

Abstract

Research Focus: The primary purpose of this project was to determine if there was an association of factors with time to first solid meal in gastrointestinal (GI) surgery patients and the impact solid diet has on length of stay (LOS) in the hospital, GI symptoms, and incidence of post-operative ileus (POI). A secondary purpose was to observe and describe when an oral diet was started and the progression of diet after GI surgery.

Research Methods: This study was a cross-sectional, retrospective chart review of a convenience sample in a multi-centered hospital system conducted in 84 GI resection patients who were 18 years of age or older, and who underwent elective laparoscopic or open bowel resection. Primary outcome variables were postoperative LOS, return to bowel function, incidence of POI, overall complication rate, and presence of GI symptoms. Exploratory variables included pre-operative preparation techniques (pre-operative fasting, bowel preparation, and pre-medication), analgesic and anesthetic techniques used, laxative use, and nasogastric tube (NGT) reinsertion and time in situ, and time to mobilization. Demographic variables included age, sex, surgery type, incision type, and body mass index (BMI). International Business Machines Statistical Package for Social Sciences (IBM SPSS) and IBM Statistical Package for the Social Sciences Analysis of Moment Structures (IBM SPSS Amos) were used to analyze data. A correlation table and individual linear and binary logistic regressions in SPSS Statistics, and pathway analysis in SPSS Amos were used to determine direct associations, indirect associations, and covariates.

Research Results/Findings: There were no significant associations between time to first solid meal and GI complications, sepsis, abscess, or other complications including hemorrhage, hypertensive thrombocytopenia, acute post-hemorrhagic anemia, hematochezia, leukocytosis, colovesical fistula, and prolapse of ileostomy. Time to first solid meal was significantly associated with allowing clear liquids 12 to 24 hours prior to surgery and time to mobilization. Both faster time to first solid diet and eating before bowel function return (BFR) were associated with decreased LOS. In this study, all except two patients received a clear liquid diet (CLD) as their first meal. Forty four percent of patients were not fed orally until after BFR. The NGT was not removed until after postoperative day 1 (POD1) in 25% of patients.

Conclusions from Research: The findings in this observational study concur with the findings of previous experimental research. Feeding an early solid meal is not associated with complications and is associated with decreased LOS.

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