Post-operative nutritional practice in emergency laparotomy

INTRODUCTION: Post-operative nutrition in emergency abdominal surgery can be challenging, and evidence on nutritional management in this population needs to be included in guidelines. This study aimed to describe the nutritional practice after emergency laparotomy at a university hospital and compare the routine practice to current guidelines. METHODS: This was a single-centre retrospective cohort study of consecutive patients undergoing emergency laparotomy from August 2021 to August 2022. Patients transferred to other hospitals or non-surgical wards were excluded. Nutritional data during admission were assessed daily from post-operative day (POD) 1 up to POD 30. RESULTS: A total of 231 patients were included; 118 (51.1%) were male, and the median age was 71 years (IQR: 58-79 years). Bowel obstruction was found in 144 (62.3%) of patients. The median length of stay was eight days (IQR: 5-14 days). Any oral intake on POD 1 was achieved by 113 (48.9%), increasing to 203 (87.9%) on POD 5. Nasogastric tubes and dietary restrictions were standard in patients not achieving oral intake on POD 1. Parenteral nutrition was used in 66 (28.6%) patients; the median time from surgery to initiation of parenteral nutrition was four days (IQR: 3-6.75 days), and the median duration of parenteral nutrition was seven days (IQR: 5-15 days). CONCLUSIONS: Early oral intake after major emergency abdominal surgery was only achieved in half of the patients, and current practice deviates from current guidelines. Special considerations should be made in patients undergoing emergency laparotomy as their post-operative condition differs from that of elective cases. FUNDING: This study was supported by the Novo Nordisk Foundation (grant number NNF22OC0079459). The Novo Nordisk Foundation was not involved in study design, data collection, analysis, interpretation or writing. TRIAL REGISTRATION: Not relevant.