Early initiation of enteral feeding in hospitalized patients with acute pancreatitis was found to be associated with reduced length of stay, according to study results presented at the Society of Hospital Medicine Annual Meeting.
“Historically, physicians have been trained to have patients fast when they develop acute pancreatitis. This approach was based on the belief that early food intake may worsen the acute inflammation associated with pancreatitis, leading to prolongation of hospitalization or complications,” Valerie M. Vaughn, MD, from University of Michigan Hospital and Health Systems, told Healio Gastroenterology. “Despite evidence to the contrary, this approach remains standard practice in many places. For this reason, we performed a systematic review and meta-analysis to compare early to delayed feeding to determine whether one was associated with worse patient and clinical outcomes.”
Vaughn and colleagues searched relevant literature and identified seven randomized controlled trials that compared early to delayed feeding in a total of 598 patients. Length of hospital stay served as the primary outcome of interest while mortality, readmissions, feeding intolerance and complications of pancreatitis and gastrointestinal symptoms served as secondary outcomes of interest.
Early feeding was found to be associated with a 1.71-day decrease in length of stay (95% CI, –2.34 to –1.08), and the association persisted in subgroup analysis of nasoenteric (P = .04) and oral feeding (P = .03).
Compared with 10.3% of patients who received late feeding, 6.4% of patients who received early feeding were readmitted to the hospital (P = .16), and feeding intolerance occurred in 6.3% of patients who received early feeding vs. 23.6% of patients who received late feeding (P = .15). Comparable rates of death, nausea, vomiting, necrotizing pancreatitis and recurrent abdominal pain occurred between groups.
“After combining data using meta-analysis, we found that feeding within 48 hours of hospital admission was associated with reductions in length of hospital stay by almost 2 days,” Vaughn said. “Importantly, this reduction in stay was not associated with greater complications such as death, readmission, and necrotizing pancreatitis or worsening clinical symptoms. Therefore, wider adoption of this strategy seems clinically reasonable and may result in substantial cost savings.” – by Adam Leitenberger
Vaughn VM, et al. Abstract 138. Presented at: SHM Annual Meeting; March 6-9, 2016; San Diego.
Disclosure: The researchers report no relevant financial disclosures.
Editor's note: This article was updated on March 10 to reflect additional information.