#182 Chew on This: Why gum is good for your post-operative bum
Reading Tools for Practice Article can earn you MainPro+ Credits
Join NowAlready a CFPCLearn Member? Log in
- Use in colorectal, gynecological, and other abdominal surgeries:
- Systematic review of 81 Randomized Controlled Trials (RCTs) comparing post-operative chewing gum to any intervention (9,072 patients):1
- Chewing gum resulted in statistically significant decreases in:
- Time to first flatus (TFF): By 10 hours.
- Time to first bowel motion (TFBM): By 13 hours.
- Length of stay (LOS): By 0.7 days.
- Other post-operative complications (like nausea/vomiting) similar.1
- Limitations: Majority small studies, open-label, patients with previous abdominal surgery or intra-operative complications often excluded.
- Chewing gum resulted in statistically significant decreases in:
- Recent high quality RCT (after systematic review): 112 Dutch patients, open colorectal surgery randomized to chewing gum or placebo dermal patch.2 Chewing gum significantly:
- Improved number of patients with first bowel motion within three days: 85% versus 57%: Number Needed to Treat (NNT)=4.
- Decreased ileus at Day 5 (27% versus 48%, NNT=5) and LOS (9.5 versus 14 days).
- Systematic review of 81 Randomized Controlled Trials (RCTs) comparing post-operative chewing gum to any intervention (9,072 patients):1
- Use with Enhanced Recovery after Surgery (ERAS) programs: Four RCTs (571 patients) post-colorectal surgery, decreased TFBM by 21 hours, but no significant difference in TFF or LOS.1
- Limitation: High quality and largest study (>72% of above patients) measured outcomes in days (not hours).3
- Cesarean sections:4 Seventeen RCTs (3,149 patients), chewing gum versus usual care significantly decreased: TFF (7 hours), TFBM (9 hours), and hospital LOS (9 hours).
- Timing of intervention, type, frequency, and duration of gum use varied across studies.1,4 Commonly, patients chewed gum 3-4 times per day, starting 2-3 hours after surgery.
- ERAS interventions, including early feeding, venous thromboembolism, antibiotic prophylaxis, laparoscopic surgery when appropriate, early mobilization, adequate analgesia, and anti-emetics5 reduce post-operative colorectal surgery complications, hospitalizations (~1-3 days),6-8 and health care costs.9
- Chewing gum for idiopathic constipation has not been studied.