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Dairy Product-Induced Diarrhea After Bowel Surgery: A Performance Improvement Opportunity

Surgical Services

Paul Sipe, MD, FACS

Surgical Services

Kristi Peters, MS

The Emig Research Center

Dale Green, MS, RD

Food and Nutrition Services, WellSpan Health, York Hospital, York, Pennsylvania

L. Peter Fielding, MD, FRCS, FACS

Surgical Services

Once gastrointestinal function has returned after bowel surgery, a dairy-based liquid diet appears to be associated with an increased incidence of diarrhea when compared with a soft-solid diet. This retrospective study explores the hypothesis that these observations are causally related. We have modeled potential clinical and cost savings benefits, which might be derived from a change in clinical practice using a clear liquid and then soft-solid diet and avoiding the use of a dairy-based liquid diet. A chart review of 257 patients who had undergone bowel surgery over a 15-month period contained 64 patients with conditions predisposing to postoperative diarrhea. These patients were excluded leaving a study population of 193 patients. A model was developed to estimate dollar cost savings based on differences between groups of patients' length of stay (LOS). Of the 193 patients studied, the majority received an early postoperative dairy-based nutritional regimen (60%), whereas the remainder (40%) progressed directly from clear fluids to a soft-solid diet. The incidence of diarrhea was substantially different between these two groups (32% vs 5%, p < .001). Patients with diarrhea had a median length of stay of 10 days (range 5 to 34), and the figure for those without diarrhea was 7 (range 2 to 28) days (p < .001). The median costs for patients with and without diarrhea were $10,337 and $6,751, respectively (p <.001). In patients with a dairy-based nutritional regimen who developed diarrhea, a change to the soft-solid diet led to diarrhea frequency reduction (X² = 12.06, p = .002). Extrapolating our findings to the national level, we estimate that approximately 560,000 patients per annum (p.a.) have a similar clinical profile. A nomogram model showed conservative estimates that there is a potential national LOS savings of approximately 200,000 days, which could save $250 million p.a. With these clinical and financial findings, a concerted prospective nationwide effort to confirm this hypothesis appears to be eminently worthwhile.

Nutrition in Clinical Practice, Vol. 16, No. 3, 147-152 (2001)
DOI: 10.1177/088453360101600304


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