Life and death of the nasogastric tube in elective colonic surgery in the Netherlands

Background & aims: There is abundant evidence that the routine use of nasogastric decompression following elective abdominal Surgery is ineffective in achieving any goals it is intended for. Nevertheless its use is still standard of care. The aim of the present study was to investigate whether it is possible to ban nasogastric decompression after elective colonic Surgery. Methods: At first baseline measurements concerning elements of perioperative care, including nasogastric tubes, were recorded retrospectively over the year 2004. In 2006-2007 the implementation of a fast-track colonic surgery project was guided by the Dutch Institute for Quality of Healthcare CBO, using Berwick's Breakthrough approach. Results: A total of 2007 patients were enrolled. The baseline measurement showed that the use of nasogastric drainage is still common practice in the Netherlands. 953 patients (88.3%) had a nasogastric tube postoperatively. That tube was removed after a median of 2.5 days (range 1-3 days). After the implementation of the Perioperative Care Breakthrough project the percentage of patients having a nasogastric tube postoperatively dropped to 9.6% (p < 0.0001). Conclusions: Our results show using the Breakthrough Methodology it is possible to eradicate the inappropriate routine use of NG tubes. (c) 2008 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.