TONIC to Evaluate Early Nutrition After Emergency Abdominal Surgery

Key takeaways:

• The TONIC trial is evaluating whether early parenteral nutrition after emergency abdominal surgery improves recovery and reduces complications.
• Results could directly influence postoperative nutritional guidelines in emergency surgery.

The multicenter, two-arm randomized controlled trial spans 25 NHS hospitals and will recruit 898 adults. Eligible participants include adults undergoing urgent or emergency laparotomy or laparoscopy procedures. The trial will compare two nutritional pathways after emergency abdominal surgery.

The intervention uses early parenteral nutrition delivered within 48 hours after surgery. Standard care may include oral supplements, nasoenteric feeding, or later parenteral nutrition when clinicians judge it necessary.

The primary outcome is complication rate and severity up to hospital discharge, and secondary measures include complications at later time points and infectious events. Additional assessments cover function, quality of life, readmissions, cost-effectiveness from NHS and societal perspectives, and patient-reported outcomes.