Gum chewing reduces postoperative ileus? A systematic review and meta-analysis

Abstract Purpose Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures. Materials and methods A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation. Results The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) − 3.46 d, 95% confidence interval (CI) − 4.94 to − 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61–0.94, p = 0.01] and time to defecation (MD − 1.37 d, 95% CI − 2.06 to − 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52–1.03, p = 0.07). Conclusion Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.

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Pharmacologic Options to Prevent Postoperative Ileus

Annals of Pharmacotherapy ◽

10.1345/aph.1m121 ◽

2009 ◽

Vol 43 (9) ◽

pp. 1474-1485 ◽

Cited By ~ 15

Author(s):

Yu-Chen Yeh ◽

Elissa V Klinger ◽

Prabashni Reddy

Keyword(s):

Web Site ◽

Postoperative Ileus ◽

Bowel Movement ◽

Data Extraction ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Composite Endpoint ◽

Bowel Dysfunction ◽

Gum Chewing ◽

Meta Analyses

Objective: To summarize the evidence on pharmacologic options in preventing postoperative ileus (POI). Data Sources: The Cochrane Database of Reviews and OVID databases and Food and Drug Administration (FDA) Web site were searched (1950–April 2009) using the term postoperative ileus. Study Selection and Data Extraction: Meta-analyses and randomized controlled trials were included for review. The FDA Web site was searched for clinical reviews and label information for drugs indicated for the prevention of POI. Data Synthesis: Three meta-analyses, 2 on gum-chewing and 1 on alvimopan, and 18 clinical trials were identified. Only gum chewing and alvimopan were effective in preventing POI. Gum chewing reduced the time to first flatus and bowel movement (weighted mean difference 21h, p = 0.0006 and 33h; p = 0.0002, respectively). In one meta-analysis, gum chewing significantly reduced length of stay (LOS) by 2.4 days (p < 0.00001) but this was not replicated in the second meta-analysis. Alvimopan shortened the time to reach a composite endpoint of solid food intake, plus/minus flatus, and bowel movement (93 vs 105 h; p < 0.001). A higher incidence of myocardial infarction was observed in a 12-month study of alvimopan for the treatment of opioid-induced bowel dysfunction, but not in studies in patients undergoing bowel resection. Alvimopan decreased the time to written hospital discharge order (hazard ratio 1.35; p<0.01), while the significance of a reduction in LOS (0.2–1.3 days) was not reported. Conclusions: Gum chewing and alvimopan are effective in preventing POI, but given safety concerns and higher cost with alvimopan, gum chewing may be preferred.

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Selective Opioid Antagonists Following Bowel Resection for Prevention of Postoperative Ileus: a Systematic Review and Meta-analysis

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-021-04973-8 ◽

2021 ◽

Author(s):

Tyler McKechnie ◽

Tharani Anpalagan ◽

Simarpreet Ichhpuniani ◽

Yung Lee ◽

Karim Ramji ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Ileus ◽

Bowel Resection ◽

Meta Analysis ◽

Opioid Antagonists

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A systematic review and meta-analysis of baseline risk factors for the development of postoperative ileus in patients undergoing gastrointestinal surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0158 ◽

2020 ◽

Vol 102 (3) ◽

pp. 194-203

Author(s):

MJ Lee ◽

P Vaughan-Shaw ◽

D Vimalachandran ◽

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Abdominal Surgery ◽

Postoperative Ileus ◽

Smoking Status ◽

Meta Analysis ◽

Gastrointestinal Surgery ◽

Baseline Risk ◽

Targeted Interventions ◽

Large Cohort Study

Introduction Postoperative ileus occurs frequently following abdominal surgery. Identification of groups at high risk of developing ileus before surgery may allow targeted interventions. This review aimed to identify baseline risk factors for ileus. Methods A systematic review was conducted with reference to PRISMA and MOOSE guidelines. It was registered on PROSPERO (CRD42017068697). Searches of MEDLINE, EMBASE and CENTRAL were undertaken. Studies reporting baseline risk factors for the development of postoperative ileus based on cohort or trial data and published in English were eligible for inclusion. Dual screening of abstracts and full texts was undertaken. Independent dual extraction was performed. Bias assessment was undertaken using the quality in prognostic studies tool. Meta-analysis using a random effects model was undertaken where two or more studies assessed the same variable. Findings Searches identified 2,430 papers, of which 28 were included in qualitative analysis and 12 in quantitative analysis. Definitions and incidence of ileus varied between studies. No consistent significant effect was found for association between prior abdominal surgery, age, body mass index, medical comorbidities or smoking status. Male sex was associated with ileus on meta-analysis (odds ratio 1.12, 95% confidence interval 1.02–1.23), although this may reflect unmeasured factors. The literature shows inconsistent effects of baseline factors on the development of postoperative ileus. A large cohort study using consistent definitions of ileus and factors should be undertaken.

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