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Intraoperative nasogastric tube during colorectal surgery may not be mandatory: a propensity score analysis of a prospective database

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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.

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*Collaborator of the GRACE group/Participating investigators who provided care for study patients

ARIMONT JM (CH Alpes Leman, Contamine Sur Arves, FRANCE), ARNALSTEEN L (Hôpital Privé La Louvière, Lille, FRANCE), ATGER J (CHICAS GAP, Gap, FRANCE), AUVRAY Sylvain (Hôpital Privé Saint Louis, Paris, FRANCE), BEGUINOT-HOLTZSCHERER S (Polyclinique de l’Europe, Saint Nazaire, FRANCE), BELOUARD A (Clinique de l’Archette, Olivet, FRANCE), BEN HENDA I (Hôpital Privé de l’Est Parisien, Aulnay sous-bois, FRANCE), BLEHAUT D (Infirmerie Protestante, Caluire, FRANCE), BONNET M (Hôpital Européen, Marseille, FRANCE), BORET H, BUISSET-SUBIRAN C and MASSA D (CHITS, Toulon, FRANCE), BOZIO G (Médipôle Savoie, Challes les Eaux, FRANCE), CASTIGLIONI M (Polyclinique Poitiers, Poitiers, FRANCE), CATINOIS ML, CHENET P (Clinique d’Argonay, Argonay, FRANCE), CHOPIN X and THIEVENAZ R (Clinique Charcot, Sainte Foy Les Lyon, FRANCE), CUELLAR E (CHU Toulouse, Toulouse, FRANCE), de ANGELIS N (Hôpital Henri Mondor, Paris, FRANCE), de la FONTAINE C (Clinique de l’Archette, Olivet, FRANCE), DENET C (Institut Mutualiste Montsouris, Paris, FRANCE), DILEON S (Clinique Saint Roch, Cavaillon, FRANCE), DOUARD R (Hôpital Européen Georges Pompidou, Paris, FRANCE), DUCHALAIS E (CHU Nantes, Nantes, FRANCE), DUFRAISSE S (CH Jacques Puel, Rodes, FRANCE), DUPRE A (Centre Léon Bérard, Lyon, FRANCE), DURAME F (CH de Longjumeau, Longjumeau, FRANCE), HUTIN E (Hôpital Privé de Versailles, Versailles, FRANCE), FERNOUX P and MASSARD JL (Hôpital privé Sainte Marie, Chalon Sur Saone, FRANCE), FRISONI R and SCHERRER ML (CHR Metz-Thionville, Ars-Laquenexy, FRANCE), GERMAIN A (CH Nancy, Nancy, FRANCE), GIGNOUX B (Clinique de la Sauvegarde, Lyon, FRANCE), GOASGUEN N (Hôpital Diaconnesses, Paris, FRANCE), GUEDJ J (Clinique Charcot, Sainte Foy Les Lyon, FRANCE), GUIGNARD B (Clinique du Val d’Or, Saint Cloud, FRANCE), Guinier D (CH Bretagne Sud, Lorient, FRANCE), HAIL K (Clinique chirurgicale B. CHU Mustapha, Alger, ALGERIA), HATWELL C (Clinique Saint Jean, Montpellier, FRANCE), JORIS J (CHU de Liège, Liège, BELGIUM), KASSOUL A (Hôpital Ambroise Paré, Boulogne-Billancourt, FRANCE), KOTHONDIS K (APP Sambre et Meuse, Sambreville, FRANCE), LANGLOIS G (Clinique Chénieux, Limoges, FRANCE), LEBAS S (Polyclinique la Pergola, Vichy, FRANCE), LEONARD D (Cliniques Universitaires Saint Luc, Bruxelles, BELGIUM), LEPORRIER J and SIRISIER F (Hôpital Privé Saint Martin, Caen, FRANCE), MARIANI A (Clinique d’Argonnay, Argonay, FRANCE), MAUVAIS F (CH Beauvais, Beauvais, FRANCE), MERGUI C and VOILIN C (Clinique la Chartreuse, Voiron, FRANCE), MESTRALLET JP (CH Annecy Genevois, Epagny Metz Tessy, FRANCE), MILOU F (HIA Desgenettes, Lyon, FRANCE), MONTAGNE S (Polyclinique Gentilly, Nancy, FRANCE), MOR MARTINEZ C (Clinique de l’Alliance, Saint Cyr S/Loire, FRANCE), OSTERMANN BUCHER S (Hirslanden Clinique la Colline, Genève, SWITZERLAND), OUAISSI M (CHRU Tours, Chambray Les Tours, FRANCE), PASSEBOIS L (CH Béziers, Béziers, FRANCE), PERROT L (Hôpital Privé Saint Martin, Caen, FRANCE), PIQUARD A (CHR Orélans, Orléans, FRANCE), PLARD L (CH Avranches-Granville, Avranches, FRANCE), PLUMEREAU F (CH Laval, Laval, FRANCE), POINCENOT J (CHIC, Créteil, FRANCE), RASPADO O (Infirmerie protestante, Caluire et Cuire, FRANCE), RAZAFINDRATSIRA T (CH Pierre Oudot, Bourgoin-Jallieu, FRANCE), REGIMBEAU JM (CHU Amiens, Amiens, FRANCE), RIBOUD R (CH de Voiron, Voiron, FRANCE), RIO D (CH Bretagne Atlantique, Vannes, FRANCE), SAINT DENIS M (Hôpital Privé d’Antony, Antony, FRANCE), SALAUN P (Le Confluent, Nouvelles cliniques Nantaises, Nantes, FRANCE), SMEETS B and LUYER M (Catarina Hospital, Endhoven, NETHERLANDS), STEINMETZ JP (Hôpital de Hautepierre, Strasbourg, FRANCE), VAUCLAIR E, LATRILLE A and ORTEGA-DEBALLON P (CHU Dijon, Dijon, FRANCE), VIGNAL JC (Polyclinique Bordeaux Rive Droite, Bordeaux, FRANCE), WOLTHUIS A (University Hospital Leuven, Leuven, BELGIUM).

Funding

Web-hosting of GRACE audit data was funded by the “Caisse National D’Assurance Maladie.”

Author information

Authors and Affiliations

  1. Department of Visceral and Endocrinal Surgery, CHU Angers, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 9, France

    Aurélien Venara & Karem Slim

  2. TENS, UMR INSERM 1235, 1 Place Alexis Ricordeau, 44000, Nantes, France

    Aurélien Venara

  3. Department of Medicine, University of Health of Angers, 49000, Angers, France

    Aurélien Venara & Jean-Francois Hamel

  4. Institut Paoli-Calmette, 232 boulevard de Sainte Marguerite, 13009, Marseille, France

    Jean-Francois Hamel

  5. Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-Sud, Université de Lyon, 69495, Pierre-Bénite Cedex, France

    Eddy Cotte

  6. Department of Visceral Surgery, CHU Grenoble, Université de Grenoble, 38700, La Tronche, France

    Hélène Meillat

  7. Department of Endocrinal and Visceral Surgery, University Hospital of Clermont Ferrand, 63003, Clermont Ferrand, France

    Pierre-Yves Sage

Authors
  1. Aurélien Venara
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  2. Jean-Francois Hamel
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  4. Hélène Meillat
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  5. Pierre-Yves Sage
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  6. Karem Slim
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Consortia

the GRACE Group*

  • J. M. Arimont
  • , L. Arnalsteen
  • , J. Atger
  • , S. Auvray
  • , S. Beguinot-Holtzscherer
  • , A. Belouard
  • , Ben Henda
  • , D. Blehaut
  • , M. Bonnet
  • , H. Boret
  • , C. Buisset-Subiran
  • , D. Massa
  • , G. Bozio
  • , M. Castiglioni
  • , M. L. Catinois
  • , P. Chenet
  • , X. Chopin
  • , R. Thievenaz
  • , E. Cuellar
  • , N. de Angelis
  • , C. de la Fontaine
  • , C. Denet
  • , S. Dileon
  • , R. Douard
  • , E. Duchalais
  • , S. Dufraisse
  • , A. Dupre
  • , F. Durame
  • , E. Hutin
  • , P. Fernoux
  • , L. Massard
  • , R. Frisoni
  • , M. L. Scherrer
  • , A. Germain
  • , A. Gignoux
  • , N. Goasguen
  • , J Guedj
  • , B. Guignard
  • , D. Guinier
  • , K. Hail
  • , C. Hatwell
  • , J. Joris
  • , A. Kassoul
  • , K. Kothondis
  • , G. Langlois
  • , S. Lebas
  • , D. Leonard
  • , J. Leporrier
  • , F. Sirisier
  • , A. Mariani
  • , F. Mauvais
  • , C. Mergui
  • , C. Voilin
  • , J. P. Mestrallet
  • , F. Milou
  • , S. Montagne
  • , C. Mor Martinez
  • , S. Ostermann Bucher
  • , M. Ouaissi
  • , L. Passebois
  • , L. Perrot
  • , A. Piquard
  • , L. Plard
  • , F. Plumereau
  • , J. Poincenot
  • , O. Raspado
  • , T. Razafindratsira
  • , J. M. Regimbeau
  • , R. Riboud
  • , D. Rio
  • , M. Saint Denis
  • , P. Salaun
  • , B. Smeets
  • , M. Luyer
  • , J. P. Steinmetz
  • , E. Vauclair
  • , A. Latrille
  • , P. Ortega-Deballon
  • , J. C. Vignal
  •  & A. Wolthuis

Contributions

Venara A: Conception, design, analysis and interpretation of data, manuscript author, provided criticism of the manuscript, drafted the article and revised it for important intellectual content. Final approval of the version to be published. Hamel JF: Methodology, statistical analysis and interpretation. Final approval of the version to be published. Meillat H: Provided care for study patients. Provided criticism of the manuscript, drafted the article and revised it for important intellectual content. Final approval of the version to be published. Cotte E: Provided care for study patients. Provided criticism of the manuscript, drafted the article and revised it for important intellectual content. Final approval of the version to be published. Sage PY: Provided care for study patients. Provided criticism of the manuscript, drafted the article and revised it for important intellectual content. Final approval of the version to be published. Slim K: Conception, design, analysis and interpretation of data. Provided criticism of the manuscript, drafted the article and revised it for important intellectual content. Final approval of the version to be published.

Corresponding author

Correspondence to Aurélien Venara.

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Conflict of interest

Aurélien Venara, Jean-Francois Hamel, Eddy Cotte, Hélène Meillat, Pierre-Yves Sage, and Karem Slim have no conflicts of interest or financial ties to disclose.

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Collaborator of the GRACE group are listed in Acknowledgement section.

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Venara, A., Hamel, JF., Cotte, E. et al. Intraoperative nasogastric tube during colorectal surgery may not be mandatory: a propensity score analysis of a prospective database. Surg Endosc 34, 5583–5592 (2020). https://doi.org/10.1007/s00464-019-07359-9

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