Evidence map›Paper›PMID 33752757›Full record

ArticlePerioperative medicine (London, England)2021

Early oral protein-containing diets following elective lower gastrointestinal tract surgery in adults: a meta-analysis of randomized clinical trials.

Hong Pu, Philippa T Heighes, Fiona Simpson, Yaoli Wang, Zeping Liang, Paul Wischmeyer, Thomas J Hugh, Gordon S Doig

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Perioperative medicine (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
2.5field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.

  1. PERIOPERATIVE CARE IN DIGESTIVE SURGERY: THE ERAS AND ACERTO PROTOCOLS - BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER.Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2024
    Guideline
  2. Review
  3. Article
  4. EARLY REFEEDING AFTER COLORECTAL CANCER SURGERY REDUCES COMPLICATIONS AND LENGTH OF HOSPITAL STAY.Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2025
    Article
  5. Article
  6. Article
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 3 countries.

Hong PuNorthern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia.
Philippa T HeighesNorthern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia.
Fiona SimpsonNorthern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia.
Yaoli WangNorthern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia.
Zeping LiangNorthern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia.
Paul WischmeyerDepartment of Anesthesiology and Surgery, Duke University, Durham, NC, USA.
Thomas J HughUpper GI Surgical Department, Royal North Shore Hospital and the University of Sydney, Sydney, Australia.
Gordon S DoigNorthern Clinical School Intensive Care Research Unit, Faculty of Medicine and Health, University of Sydney, Kolling Building-RNSH, Pacific Hwy, St Leonards, NSW, 2065, Australia. Gordon.Doig@EvidenceBased.net.
Northern Sydney Local Health District · AUUniversity of Sydney · AUDuke University · USWest China Hospital of Sichuan University · CN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough current guidelines make consensus recommendations for the early resumption of oral intake after surgery, a recent comprehensive meta-analysis failed to identify any patient-centered benefits. We hypothesized this finding was attributable to pooling studies providing effective protein-containing diets with ineffective non-protein liquid diets. Therefore, the aim of this paper was to investigate the safety and efficacy of early oral protein-containing diets versus later (traditional) feeding after elective lower gastrointestinal tract surgery in adults.

methodsPubMed, Embase, and the China National Knowledge Infrastructure databases were searched from inception until 1 August 2019. Reference lists of retrieved studies were hand searched to identify randomized clinical trials reporting mortality. No language restrictions were applied. Study selection, risk of bias appraisal and data abstraction were undertaken independently by two authors. Disagreements were settled by obtaining an opinion of a third author. Majority decisions prevailed. After assessment of underlying assumptions, a fixed-effects method was used for analysis. The primary outcome was mortality. Secondary outcomes included surgical site infections, postoperative nausea and vomiting, serious postoperative complications and other key measures of safety and efficacy.

resultsEight randomized clinical trials recruiting 657 patients were included. Compared with later (traditional) feeding, commencing an early oral protein-containing diet resulted in a statistically significant reduction in mortality (odds ratio [OR] 0.31, P = 0.02, I

conclusionsThe results of this systematic review can be used to upgrade current guideline statements to a grade A recommendation supporting an oral protein-containing diet commenced before the end of postoperative day 1 after elective lower gastrointestinal surgery in adults.

Indexed as

Elective surgeryMeta-analysisMortalityPostoperative nutritionProtein

Identifiers

PMID33752757
PMCPMC7986268
OpenAlexW3137405586

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.