Impact of Early Enteral Nutrition on Hospital Length of Stay After Penetrating Bowel Injury: A Retrospective Cohort Study from Taiz, Yemen

Abstract

Background: Penetrating bowel injury (PBI) following armed conflict carries substantial postoperative morbidity in low-resource settings. Early enteral nutrition (EEN) is recommended by international guidelines to attenuate surgical stress and accelerate recovery, yet evidence from conflict-affected populations remains scarce.

Objectives: This study aimed to evaluate the impact of early enteral nutrition on hospital length of stay among patients undergoing surgery for penetrating bowel injury at Al-Safwa Hospital, Taiz, Yemen.

Methods: A retrospective cohort study was conducted of patients who underwent emergency surgery for penetrating bowel injury between 2017 and 2023. Patients were classified into two groups according to postoperative feeding strategy: early enteral nutrition (EEN), defined as initiation of enteral feeding within 48 hours of surgery, and delayed enteral nutrition (DEN), defined as commencement after 48 hours. The primary outcome was hospital length of stay. Secondary outcomes included time to first bowel movement, postoperative complication rate, surgical site infection, anastomotic leak, and in-hospital mortality. Univariate and multivariate analyses were performed to identify independent predictors of prolonged hospital stay.

Results: A total of 109 patients were included; 83.5% sustained gunshot wounds and 51.4% had isolated small bowel injuries. Patients in the EEN group demonstrated significantly shorter hospital length of stay compared with the DEN group. EEN was also associated with earlier return of bowel function, lower overall complication rates, and fewer infectious complications. The overall complication rate was 26.6%, and in-hospital mortality was 2.8%. On multivariate analysis, delayed enteral nutrition and operative duration exceeding three hours were independent predictors of prolonged hospital stays.

Conclusion: Early enteral nutrition was associated with significantly shorter hospital length of stay and improved postoperative outcomes following surgery for penetrating bowel injury in a conflict-affected, resource-limited Yemeni setting. These findings support the integration of structured early feeding protocols into postoperative care pathways for trauma laparotomy in austere environments.