Background and importance Flatus is an important indicator of postoperative recovery of gastrointestinal function. Gum chewing is a cheap and simple intervention that mimics food intake to stimulate the vagus nerve and bowel movements.
Aim and objectives To confirm the efficacy of gum chewing through an evidence approach and to implement this approach through interprofessional teamwork.
Material and methods Evidence approach: setting the patient, intervention, comparison and outcome (PICO) to form a therapy question. In the Pubmed, Cochrane and Embase databases, using MeSH terms and Boolean logic combinations (chewing gum AND (colorectal surgery OR colostomy) AND postoperative ileus) for the literature search. Filters activated were randomised controlled trial (RCT), published from 2000 to 2018, in humans. Eleven RCTs were selected for review and showed a trend in improvement in the time to first flatus, starting feeding and discharge.
Implementation we formed an interprofessional team including physicians, nurses, dieticians and pharmacists. The study involved 39 patients who underwent colorectal surgery between March and August 2018. In the gum chewing group, 19 patients took gum three times a day on the first day after surgery until the first flatus. Twenty patients who disagreed with gum chewing were in the control group. Evaluation of the findings was done with analysis of covariance (ANCOVA).
Results Compared with the control group, the time to first flatus and the start of feeding were shorter in the gum chewing group (66.97±24.78 vs 54.82±19.74 hours and 91.53±51.41 vs 74.77±21.54 hours, respectively). However, the difference was not significant (p=0.166, 0.283). The time to discharge was significantly shorter in the gum chewing group (12.55±5.96 vs 9.16±1.71 days, p=0.047). Other influencing factors for the time to first flatus, start of feeding and discharge were analysed (eg, taking promotility agents, such as metoclopramide), but no significant differences were found between the two groups (p=0.375, 0.162, 0.960).
Conclusion and relevance Could evidence based medicine lead to an equally satisfying practice? The implementation of the interprofessional team was essential (eg, the core physician team had not participated at the beginning and thus missed many possible cases).
References and/or acknowledgements No conflict of interest.
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