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Early enteral feeding in adult patients after colorectal surgery: a systematic review Singapore National University Hospital Centre for Evidence Based Nursing: A collaborating centre of the Joanna Briggs Institute, Singapore.

Review Questions/Objectives 
The objective of this systematic review is to synthesise the best available quantitative research evidence on the early enteral feeding in adult patients (18 + years old) after colorectal surgery in the hospital setting. 
 
Review questions 
The specific review questions to be addressed are: 
- What is the effect of early enteral feeding on the wound infections and intra-abdominal abscesses? 
- What is the effect of early enteral feeding on the post-operative complications? 
- What is the effect of early enteral feeding on the anastomotic leakages? 
- What is the effect of early enteral feeding on the mortality within 30 days after colorectal surgery? 
- What is the effect of early enteral feeding on the length of hospital stay? 
- What are the significant adverse effects of early enteral feeding? 
- What are the factors influencing early enteral feeding after colorectal surgery? 
 
Types of participants 
The review will consider studies that include male and female adult patients who are 18 years old and above, of all ethnic groups with malignant and benign colorectal diseases, who have undergone colorectal surgery, receiving early enteral feeding. Patients younger than 18 years old receiving any types of surgery and patients on parenteral nutrition will be excluded from the review. 
 
Types of interventions 
The review will consider studies that include the intervention of early enteral feeding, regardless of method of enteral feeding (tube, sip or oral), defined as nutrition provided to patients undergone gastrointestinal surgery, within the first 24 hours post-operatively. The comparator group will receive regular care, with feeding commencing only after their post-operative ileus resolved. 
 
Context 
The review will consider studies that include contexts such as the acute adult? surgical care hospital settings in all countries. Studies with paediatric acute hospital settings will be excluded from the review. 
 
Types of Outcomes 
The outcomes of interest include but are not restricted to the following: 
•wound infections rates 
• intra-abdominal abscesses rates 
•post-operative complications with the number of occurrence of events such as acute myocardial infarction, post-operative thrombosis or pneumonia 
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