Background: Enhanced Recovery After Surgery (ERAS) is a perioperative programme to accelerate recovery. Nutrition ERAS components include preoperative carbohydrate loading and reduced preoperative/postoperative fasting. Postoperative chewing gum (CG) may be a useful nutrition-related practice to reduce ileus duration/onset through sham feeding. Patient involvement is central to ERAS, and studies indicate that patients perceive nutrition as an important ERAS component requiring improvement. Current adherence to, and predictors of, ERAS nutrition practices are uncertain. Aims: This thesis aims to: Systematically review the evidence for CG for postoperative recovery, Explore patient perioperative nutrition experiences, Investigate postoperative feeding practices in colorectal surgical patients. Findings will be synthesised to provide an overall investigation into the current role of nutrition practices in perioperative care. Methods: Three studies were conducted: a systematic review (SR)/meta-analysis assessing evidence from randomised-controlled trials for the effects of CG on postoperative recovery; a qualitative interview study exploring patient experiences of perioperative nutrition; and a secondary data analysis observational study investigating current adherence to, and predictors/outcomes associated with, early postoperative feeding. Results: SR results (from 81 RCTs) suggested that CG may reduce time to first flatus (l0.4h), bowel movement (TBM) (12.7h), and length of hospital stay (LOHS) (0.7d). In the qualitative study, four themes affecting perioperative nutrition experiences were identified (preparation/autonomy/relationship with food/hospital environment), from which barriers/facilitators to perioperative nutrition practices were observed. In the observational study 66% and 33% of participants respectively consumed and tolerated solid food early. Opiate analgesics and open/converted-to-open surgery were associated with delayed food tolerance. Early postoperative feeding was associated with reduced TBM/LOHS. Conclusions: Findings suggest that postoperative CG may be useful clinically. Patients' perioperative nutrition experiences could be improved by addressing patient-perceived barriers/facilitators, and vulnerable patients could be characterised from predictors of delayed postoperative feeding. Future research may be warranted exploring CG use alongside ERAS, and targeting patient-perceived barriers to nutrition practices and vulnerable patients.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:702733 |
| Date | January 2016 |
| Creators | Short, Vaneesha Corinne |
| Publisher | University of Bristol |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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