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Early Use Of Low Residue Diet Is Superior To Clear Liquid Diet After Elective Colorectal Surgery
Cheryl C.L Lau*, Edwards Philips, Catherine Bresee*, Philip R Fleshner*
Cedars Sinai Medical Center, Los Angeles, California, CA

Background:
Diet advancement after surgery traditionally starts gradually with liquids, based on a fear that early solid intake may increase nausea, vomiting, overall complications and hospital stay (LOS). A randomized controlled trial comparing LRD and CLD on postoperative day (POD) 1 was performed.
Methods:
From December 2012 to May 2013, 111 elective colorectal surgery patients were randomized to CLD (n=57) or LRD (n=54). Primary end points were nausea (Likert scale score) and vomiting on POD 2. Secondary endpoints included days to flatus (DTF), postoperative morbidity and length of hospital stay (LOS).
Results:
Patient characteristics, operative time, postoperative opioid and anti-emetic use were similar between study arms. CLD vs LRD results were: vomiting (28% vs 14%; p=0.09), and significant decrease in mean nausea score (4.70 vs 3.52;p=0.01), DTF (4.8 vs 3.7;p=0.04), and LOS (7.0 vs 5.0 days; p=0.01). LOS remained significantly shorter even after adjusting for significant covariates (laparoscopic technique, surgical site, postop comorbidity, stoma, and nasogastric tube) with LRD patients having an adjusted 1.3 day decrease in LOS (p<0.01). There was no significant difference in morbidity between study arms. Multivariate analysis of all secondary endpoints confirmed an overall significant improvement in outcomes for LRD vs CLD (p<0.01).
Conclusion:
LRD, rather than CLD, on POD1 after colorectal surgery is associated with less nausea and vomiting, faster return of bowel function and a shorter hospital stay without increasing postoperative morbidity.

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