Audit of nasogastric feeding practice at two acute hospitals: is early enteral feeding associated with reduced mortality and hospital stay?

Hospital malnutrition is common and thought to be a cause of morbidity and mortality. Nasogastric (NG) feeding is the most commonly used invasive technique of nutritional support used at the acute Bolton hospitals. A prospective observational study was initiated to audit the use of NG feeding in patients in whom oral energy intake was virtually nil at the time of commencement of tube feeding.
Patients who were starved for 0–5 days prior to commencement of NG feeding had a lower mortality than patients starved >5 days (a) during their feeding episode and (b) during their hospital stay subsequent to cessation of oral intake. The difference in mortality was not related to age or sex. However, in patients of <65 years mortality was only non-significantly higher in patients starved >5 days compared with those starved 0–5 days. In patients of >64 years the difference in mortality between those starved 0–5 vs. >5 days remained significant: (a) during the feeding episode and (b) during the hospital stay. The fact that starvation has a disproportionate effect on mortality in old patients may indicate that older patients are more susceptible to starvation. In surviving patients there was a positive correlation between the length of starvation and: (a) the duration of the NG feeding episode and (b) hospital stay subsequent to cessation of oral intake. Disease severity was not measured therefore its effect on outcome and speed of rehabilitation cannot be excluded.
The study indicates a possible relationship between the duration of starvation and mortality, the duration of NG feeding and the length of hospital stay. Definitive testing of this association would require a prospective trial which controls for age and disease severity.