Association of operating time and gastrectomy with initiation of postoperative oral food intake

Background: Fast-track programs optimizing perioperative care have been initiated along with the advancement of laparoscopic colorectal surgery. To clarify that these programs were evidence based for gastrectomy cases, we assessed the effect of operating time and gastrectomy type [open partial (OPG), open total (OTG), laparoscopic partial (LPG) and laparoscopic total (LTG)] on postoperative commencement of oral food intake. Methods: Among 14,465 cases of gastrectomy across 837 hospitals, we examined the demographics, comorbidity, complications, postoperative epidural analgesia, rehabilitation and teaching status. The impact of gastrectomy type and operating time on postoperative fasting period was assessed using mixed regression models to distill off the hospital practice belief. Results: We identified 2,775 laparoscopic gastrectomies and 10,064 partial gastrectomies, 2,485 of which were conducted via laparoscopy. Operating time was shortest in OPG and longest in LTG. The fasting period was shortest in LPG and longest in OTG. Longer operating time prolonged the fasting period, except for LTG. Postoperative epidural analgesia and earlier rehabilitation, but not laparoscopic gastrectomy, were associated with a shortened fasting period. Conclusion: When developing a fast-track program for gastrectomy, clinicians should recognize the impact of longer operating time and perioperative care rather than that of gastrectomy type on oral intake.