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

• Published in: Nutrition in clinical practice 2001-06, Vol.16 (3), p.147-152
• Main Authors: Stike, Rose L., Sipe, Paul, Peters, Kristi, Green, Dale, Fielding, L. Peter
• Format: Article
• Language: English
• ISSN: 0884-5336; 1941-2452
• DOI: 10.1177/088453360101600304

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