Effect of direct oral feeding following minimally invasive esophagectomy on costs and quality of life

M. Pattamatta, L.F.C. Fransen, A.C.P. Dolmans-Zwartjes, G.A.P. Nieuwenhuijzen, S.M.A.A. Evers, E.A. Kouwenhoven, M.J. van Det, M. Hiligsmann, M.D.P. Luyer*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


AimsFollowing (minimally invasive) esophagectomy, patients often rely on tube feeding, since oral intake is often delayed. Consequently, additional support by a dietician and home care is needed until oral intake is commenced. In this study, the effects of direct start of oral feeding compared with tube feeding following an esophagectomy was evaluated on treatment costs and health-related quality of life (QoL).MethodsPatients undergoing a minimally invasive esophagectomy were randomized in the NUTRIENT II study between controls (nil-per-mouth during 5 days and subsequent tube feeding) and a group in whom oral feeding was started directly postoperatively. Total hospital costs (including readmission and outpatient costs) and home care data for a period of 6 months after surgery were analyzed. QoL (measured using EORTC-QLQ-C30 and EORTC OG-25) was assessed preoperatively and 6 weeks, 12 weeks, and 6 months postoperatively.ResultsA total 132 patients were included (n = 65 direct oral feeding group and n = 67 control group). Mean patient hospital costs were euro26,014 in the intervention group over a 6-month period compared to euro26,989 in the control group (p = .825). Furthermore, people with direct oral feeding required significantly less home care assistance; i.e. 23 (48.9%) intervention patients versus 37 (77.1%) control patients (p = .004). Also, QoL in patients with direct oral feeding progressed more quickly when compared to the control group.LimitationsHospital costs were derived from a single hospital unit whereas costs from all the participating units may be a better reflection of the cost deviation. Availability of homecare data was limited, leading to difficulty in detecting differences in costs.ConclusionThis study suggests that direct oral feeding leads to similar total costs and a significantly reduced need for home care assistance. Furthermore, QoL in intervention group increased more quickly when compared to the control group.
Original languageEnglish
Pages (from-to)54-60
Number of pages7
JournalJournal of Medical Economics
Issue number1
Publication statusPublished - 1 Jan 2021


  • cancer
  • complications
  • direct oral feeding
  • esophagectomy
  • home care
  • hospital costs
  • jejunostomy
  • quality of life
  • resection
  • survival
  • Direct oral feeding

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