A systematic review of feeding practices among
postoperative patients: is practice in-line with
& B. Desbrow
School of Allied Health Sciences, Grifﬁth University, Southport, QLD, Australia
Menzies Health Institute Queensland, Grifﬁth University, Southport, QLD, Australia
National Centre of Research Excellence in Nursing (NCREN), Grifﬁth University, Southport, QLD, Australia
School of Nursing and Midwifery, Grifﬁth University, Southport, QLD, Australia
early oral feeding, perioperative care,
postoperative care, early recovery after surgery.
Megan Rattray, School of Allied Health Sciences,
Grifﬁth University, Southport, QLD, Australia.
Tel.: +61 567 80 154
How to cite this article
Rattray M., Roberts S., Marshall A. & Desbrow B.
(2018) A systematic review of feeding practices
among postoperative patients: is practice in-line
with evidenced-based guidelines? J Hum Nutr
Diet. 31, 151–167
Background: Early oral feeding after surgery is best practice among adult,
noncritically ill patients. Evidenced-based guidelines (EBG) recommend
commencing liquid and solid feeding within 24 h of surgery to improve
patient (e.g. reduced morbidity) and hospital (e.g. reduced length of stay)
outcomes. Whether these EBG are adhered to in usual clinical practice
remains unknown. The present study aimed to identify the time to com-
mencement of ﬁrst oral feed (liquid or solid) and ﬁrst solid feed among
postoperative, noncritically ill, adult patients.
Methods: MEDLINE, CINAHL, SCOPUS and Web of Science databases
were searched from inception to June 2016 for observational studies report-
ing liquid and/or solid feeding practices among postoperative patients. Stud-
ies reporting a mean/median time to ﬁrst feed or ﬁrst solid feed within 24 h
of surgery or where ≥75% of patients were feeding by postoperative day one
were considered in-line with EBG.
Results: Of 5826 articles retrieved, 29 studies were included. Only 40% and
22% of studies reported time to ﬁrst feed and time to ﬁrst solid feed in-line
with EBG, respectively. Clear and free liquids were the ﬁrst diet types com-
menced in 86% of studies. When solids were commenced, 44% of studies
reported using various therapeutic diet types (e.g. light) prior to the com-
mencement of a regular diet. Patients who underwent gastrointestinal proce-
dures appeared more likely to experience delayed postoperative feeding.
Conclusions: Our ﬁndings demonstrate a gap between postoperative feeding
evidence and its practical application. This information provides a strong
rationale for interventions targeting improved nutritional care following
The traditional postoperative feeding approach dictates
fasting patients until the return of bowel function (e.g. pas-
sage of ﬂatus and/or stool or bowel sounds)
approach was designed to avoid paralytic ileus (leading to
vomiting, aspiration pneumonia and wound dehiscence)
and/or anastomotic leakage thought to occur if fed prema-
. However, there is little evidence to suggest that
these adverse outcomes are likely to occur, particularly fol-
lowing nongastrointestinal surgeries
. Traditional post-
operative feeding results in substantial periods of avoidable
inadequate nutritional intake among patients who may
already be at nutritional risk, and who require optimal
ª 2017 The British Dietetic Association Ltd.
Journal of Human Nutrition and Dietetics