الفهرس 
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Abstract
Perioperative nutritional therapy has been a key, albeit somewhat neglected, aspect of perioperative care ever since Studley showed that patients with a preoperative weight loss of more than 20% had a 10-fold greater mortality after an operation for perforated peptic ulcer than those with a weight loss of less than 20%. Although many other studies have linked malnutrition with adverse postoperative outcomes, perioperative nutritional optimization is still far from universal.
Studies have looked at whether feeding patients sooner after surgery can help reduce complications (e.g., pneumonia), but there are mixed results.
Enhanced Recovery After Surgery programs recommend early oral nutrition, but this is dependent on early recovery of gastrointestinal function, which is in turn dependent on implementation of multimodal interventions aimed at aiding postoperative recovery. Even with ideal preoperative and intraoperative care, optimal early oral nutrition may not be possible in all patients, especially those undergoing major upper gastrointestinal or pancreatic operations.
So, the aim of this study was to evaluate the role of early enteral nutrition in the incidence of serious complications after major surgery. To elucidate our aim, this study was a prospective cohort observational study that was conducted on 229 patients who were admitted to ICU of Benha University Hospitals, Qalyubia. During the period study from Aprile 2022 to May 2023.
All patients were divided into two groups: group I: included 100 patients with early” start feeding as soon as possible after surgery, and group II: included 100 patients usual ”start feeding after patient pass flatus or stool.
All patients were subjected to the following on admission:
Full history taking including: age, sex, BMI, and weight. Full clinical examination: focusing on: Complete blood count, Kidney function tests (serum urea & creatinine) and Liver function tests (ALT, AST, serum transaminases, serum bilirubin (total and direct) and serum albumin)), Serum electrolytes (Serum sodium, chloride and potassium, phosphorus, calcium), C-reactive protein, Arterial blood gas and Nutritional Risk Screening was evaluating the nutritional status during feeding techniques.
The results of this study could be summarized as follow:
• The mean age of the patients in group (A) was 60.3±12.2 and 59.8 ±10.3 for group (B) 62% of the study population in group (A) were males and 60% of the group (B) were males. No statistically significant difference was found between the two groups regarding demographic data (P>0.05).
• Among the study population, in group (A) we found that 35 (35%) patients had orthopedic surgery, 33 (33%) had GIT surgery, 20 (20%) had cardiothoracic diseases, 10 (10%) had neurosurgery, and 2 (2%) had other gastrointestinal cancers. In group (B), 46 (46%) had orthopedic surgery, 31 (31%) had GIT surgery, 14 (14%) had neurosurgery, 6 (6%) had other gastrointestinal cancers and 3 (3%) had cardiothoracic diseases.
• white blood cell was significantly higher among group (A) (6260±2370) than group (B) (5830±1740), (P=0.042). As well as, C-reactive protein was significantly higher among group (B) (72±1.27) than group (A) (48±2.01), (P=0.015).
• Hypoglycemia during intervention was found in 6 (6%) of patients group (A) and in 1 (1%) of patients group (B) with significant difference between the two groups (P=0.001). Among patients who had infection, airway or lung was the most infection found in the group (A) and group (B) (16% and 19%) respectively, with significant difference between the two groups (P=0.04).
• Peak C-reactive protein level during ICU stay found in 58 (58%) of patients group (A) had and in 76 (76%) of patients group (B) with significant difference between the two groups (P<0.001). Also, patients who stay at hospital> 7 days was most in group (B) 51 (51%) and found in 45 (45%) of group (A) with significant difference between the two groups (P=0.02).
• duration of mechanical ventilation> 2 days found in in 34 (34%) of patients group (A) had and in 41 (41%) of patients group (B) with significant difference between the two groups (P=0.006).