When Should Feeds Be Resumed After Surgical Feeding Tube Placement? A Survey of East Members

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Critical Care Medicine





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Introduction: Many severely injured trauma patients require nutritional support, and those requiring long-term enteral access often undergo placement of Surgical Feeding Tube (SFT), including Percutaneous Endoscopic Gastrostomy (PEG), Lap G-tube and Open G-tube. Feeding practices following SFT are suspected to be highly variable. This study was performed to determine national practice patterns for feeding surgical patients after SFT. Methods: A 16-question online survey was administered to EAST members via Qualtrics about feeding after SFT placement. Questions included demographics, training, current practice, number of SFT performed annually. Respondents were asked when they resume feeds after SFT: < 2, 6, 12, or 24 hrs; what method they use to advance feeds to goal; and what factors influence their management decisions. For comparison, responses were grouped into “early” (<= 6hrs) and “late” (18-24 hrs) groups. Results: 516 EAST members completed the survey (25% response rate). Most (95%) respondents worked at a Level 1 or 2 trauma center (TC), and 68% are in academic practice. The majority completed general surgery residency (90%) and SCC fellowship (83%). Most common feeding tube placement was PEG (mean 30/yr, range 0-104) followed by open G-tube (4.5, 0-25) and laparoscopic G-tube (3.2, 0-30). For patients undergoing PEG, there was wide variability in when respondents initiated feeds: 27.3% started <2hrs, 31.3% in 6 hrs, 10.9% in 18 hrs and 30.1% in 24 hrs. Advancement was mostly by starting at low rate and advancing as clinically tolerated (45%), followed by starting at previously tolerated rate (33%). Reasons given for personal practice included 52% hospital policy, 60% evidence-based data, 26% teaching and 20% colleagues. Feeding practices were not affected by age (<=42yrs), TC designation, high volume SFT per year, or training programs at the respondents’ hospital (p=NS). Conclusions: Despite trials showing safety of early feeding in other patient populations, there is wide variability in practice. Given the large quantity of SFT procedures performed, a randomized controlled trial should be performed to determine the optimal timing to resume feeds in trauma patients.





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