Intraoperative nasogastric tube during colorectal surgery may not be mandatory: a propensity score analysis of a prospec
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and Other Interventional Techniques
Intraoperative nasogastric tube during colorectal surgery may not be mandatory: a propensity score analysis of a prospective database Aurélien Venara1,2,3 · Jean‑Francois Hamel3,4 · Eddy Cotte5 · Hélène Meillat6 · Pierre‑Yves Sage7 · Karem Slim1 · the GRACE Group* Received: 18 August 2019 / Accepted: 24 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Avoiding the use of nasogastric tubes (NGTs) is recommended after colorectal surgery but there is no consensus on intraoperative gastric decompression using NGTs during colorectal surgery. The objective was to assess the effect of avoiding insertion of NGTs during colorectal surgery for the recovery of gastrointestinal (GI) functions. Method 1561 patients undergoing colorectal surgery, for whom information on NGT use was available, were included in this retrospective analysis and propensity score analysis of the prospective GRACE Audit database. Patients who did and did not have an NGT during surgery were compared. Results Among the study population of 1561 patients, 696 patients were matched to correct baseline differences between groups. The no-NGT group significantly improved GI motility impairment (e.g., less postoperative nausea [OR = 0.59; CI 95%: 0.42–0.84] and a better tolerance of early feeding [OR = 2.07; CI 95%: 1.33–3.22]). Such an association was also highlighted for reduced postoperative morbidity [OR = 0.60; CI 95%: 0.43–0.83], and especially pulmonary complications [OR = 0.08; CI 95%: 0.01–0.59], or parietal complications [OR = 0.29; CI 95%: 0.09–0.87]. The risk of postoperative ileus was not significantly reduced in the no-NGT group [OR = 0.67; CI 95%: 0.43–1.06]. Conclusion No NGT insertion during colorectal surgery is safe and could improve postoperative GI function recovery. Keywords Intraoperative gastric decompression · Nasogastric tube · Colorectal surgery · Postoperative nausea and vomiting · Nasogastric tube · Early feeding tolerance It is now recognized and recommended that decompression nasogastric tubes (NGTs) should not be left in place after elective colorectal surgery [1, 2]. There is a consensus within the literature regarding the lack of benefits on the Collaborator of the GRACE group are listed in Acknowledgement section. * Aurélien Venara [email protected] 1
Department of Visceral and Endocrinal Surgery, CHU Angers, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France
2
TENS, UMR INSERM 1235, 1 Place Alexis Ricordeau, 44000 Nantes, France
3
Department of Medicine, University of Health of Angers, 49000 Angers, France
4
Institut Paoli-Calmette, 232 boulevard de Sainte Marguerite, 13009 Marseille, France
recovery of gastrointestinal (GI) functions or on the number of infections [3, 4]. Furthermore, some evidence seems to suggest that the absence of an NGT could improve the recovery of GI functions and the presence of an NGT could increase the number of postoperative infections [5]. The recommendations
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