Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection
Background Chewing gum may stimulate gastrointestinal motility, with beneficial effects on postoperative ileus suggested in small studies. The primary aim of this trial was to determine whether chewing gum reduces length of hospital stay (LOS) after colorectal resection. Secondary aims included exam...
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| Veröffentlicht in: | British journal of surgery 2016-07, Vol.103 (8), p.962-970 |
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| container_title | British journal of surgery |
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| creator | Atkinson, C. Penfold, C. M. Ness, A. R. Longman, R. J. Thomas, S. J. Hollingworth, W. Kandiyali, R. Leary, S. D. Lewis, S. J. |
| description | Background
Chewing gum may stimulate gastrointestinal motility, with beneficial effects on postoperative ileus suggested in small studies. The primary aim of this trial was to determine whether chewing gum reduces length of hospital stay (LOS) after colorectal resection. Secondary aims included examining bowel habit symptoms, complications and healthcare costs.
Methods
This clinical trial allocated patients randomly to standard postoperative care with or without chewing gum (sugar‐free gum for at least 10 min, four times per day on days 1–5) in five UK hospitals. The primary outcome was LOS. Cox regression was used to calculate hazard ratios for LOS.
Results
Data from 402 of 412 patients, of whom 199 (49·5 per cent) were allocated to chewing gum, were available for analysis. Some 40 per cent of patients in both groups had laparoscopic surgery, and all study sites used enhanced recovery programmes. Median (i.q.r.) LOS was 7 (5–11) days in both groups (P = 0·962); the hazard ratio for use of gum was 0·94 (95 per cent c.i. 0·77 to 1·15; P = 0·557). Participants allocated to gum had worse quality of life, measured using the EuroQoL 5D‐3L, than controls at 6 and 12 weeks after operation (but not on day 4). They also had more complications graded III or above according to the Dindo–Demartines–Clavien classification (16 versus 6 in the group that received standard care) and deaths (11 versus 0), but none was classed as related to gum. No other differences were observed.
Conclusion
Chewing gum did not alter the return of bowel function or LOS after colorectal resection. Registration number: ISRCTN55784442 (http://www.controlled-trials.com).
No advantage observed |
| doi_str_mv | 10.1002/bjs.10194 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5084762</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1797876006</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4754-c0e968d2a5b3190eced4a432d6eca7f29142833452c1621ee183d806fa5a985f3</originalsourceid><addsrcrecordid>eNp9UstuFDEQtBCILIEDP4AsceEyxI_x64JEAgmJlocIiKPl9fRsvMyMF3tmQ_L1MdmwAg5c7JK6qlStLoSeUvKSEsIOFqtcADX1PTSjXIqKUanvoxkhRFWUM76HHuW8IoRyIthDtMcUraUyfIbaz25oYh-uocG-C0PwrsNjCuWNLV7HPMY1JDeGDWB_AZdhWOLl1OMNpDxlnMcid6loXQLs2hES9rGLCfxYLBLkAkIcHqMHresyPLn799HX47dfjt5V848np0ev55WvlagrT8BI3TAnFpwaAh6a2tWcNRK8Uy0ztGaa81owTyWjAFTzRhPZOuGMFi3fR6-2vutp0UPjYRiT6-w6hd6lKxtdsH9PhnBhl3FjBdG1kqwYvLgzSPHHBHm0fcgeus4NEKdsqTJKK0mILNTn_1BXcUpDWc9SU45BFJPqvyxlpKJaGV1Yz_7MvQv8-1CFcLAlXIYOrnZzSuyvBtjSAHvbAHt4dn4LiqLaKkIe4edO4dJ3W2IpYb99OLHsfP7m_bH8ZCm_AewLsvY</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1796718798</pqid></control><display><type>article</type><title>Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Atkinson, C. ; Penfold, C. M. ; Ness, A. R. ; Longman, R. J. ; Thomas, S. J. ; Hollingworth, W. ; Kandiyali, R. ; Leary, S. D. ; Lewis, S. J.</creator><creatorcontrib>Atkinson, C. ; Penfold, C. M. ; Ness, A. R. ; Longman, R. J. ; Thomas, S. J. ; Hollingworth, W. ; Kandiyali, R. ; Leary, S. D. ; Lewis, S. J.</creatorcontrib><description>Background
Chewing gum may stimulate gastrointestinal motility, with beneficial effects on postoperative ileus suggested in small studies. The primary aim of this trial was to determine whether chewing gum reduces length of hospital stay (LOS) after colorectal resection. Secondary aims included examining bowel habit symptoms, complications and healthcare costs.
Methods
This clinical trial allocated patients randomly to standard postoperative care with or without chewing gum (sugar‐free gum for at least 10 min, four times per day on days 1–5) in five UK hospitals. The primary outcome was LOS. Cox regression was used to calculate hazard ratios for LOS.
Results
Data from 402 of 412 patients, of whom 199 (49·5 per cent) were allocated to chewing gum, were available for analysis. Some 40 per cent of patients in both groups had laparoscopic surgery, and all study sites used enhanced recovery programmes. Median (i.q.r.) LOS was 7 (5–11) days in both groups (P = 0·962); the hazard ratio for use of gum was 0·94 (95 per cent c.i. 0·77 to 1·15; P = 0·557). Participants allocated to gum had worse quality of life, measured using the EuroQoL 5D‐3L, than controls at 6 and 12 weeks after operation (but not on day 4). They also had more complications graded III or above according to the Dindo–Demartines–Clavien classification (16 versus 6 in the group that received standard care) and deaths (11 versus 0), but none was classed as related to gum. No other differences were observed.
Conclusion
Chewing gum did not alter the return of bowel function or LOS after colorectal resection. Registration number: ISRCTN55784442 (http://www.controlled-trials.com).
No advantage observed</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.10194</identifier><identifier>PMID: 27146793</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Aged ; Chewing Gum ; Clinical trials ; Colectomy ; Defecation ; Female ; Flatulence ; Gastrointestinal Motility ; Health risk assessment ; Humans ; Ileus - prevention & control ; Length of Stay - statistics & numerical data ; Male ; Postoperative Care ; Postoperative Complications - classification ; Postoperative Complications - epidemiology ; Postoperative period ; Quality of Life ; Randomized Clinical Trial ; Single-Blind Method ; United Kingdom - epidemiology</subject><ispartof>British journal of surgery, 2016-07, Vol.103 (8), p.962-970</ispartof><rights>2016 The Authors. published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.</rights><rights>2016 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.</rights><rights>Copyright © 2016 BJS Society Ltd. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4754-c0e968d2a5b3190eced4a432d6eca7f29142833452c1621ee183d806fa5a985f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.10194$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.10194$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27146793$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Atkinson, C.</creatorcontrib><creatorcontrib>Penfold, C. M.</creatorcontrib><creatorcontrib>Ness, A. R.</creatorcontrib><creatorcontrib>Longman, R. J.</creatorcontrib><creatorcontrib>Thomas, S. J.</creatorcontrib><creatorcontrib>Hollingworth, W.</creatorcontrib><creatorcontrib>Kandiyali, R.</creatorcontrib><creatorcontrib>Leary, S. D.</creatorcontrib><creatorcontrib>Lewis, S. J.</creatorcontrib><title>Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
Chewing gum may stimulate gastrointestinal motility, with beneficial effects on postoperative ileus suggested in small studies. The primary aim of this trial was to determine whether chewing gum reduces length of hospital stay (LOS) after colorectal resection. Secondary aims included examining bowel habit symptoms, complications and healthcare costs.
Methods
This clinical trial allocated patients randomly to standard postoperative care with or without chewing gum (sugar‐free gum for at least 10 min, four times per day on days 1–5) in five UK hospitals. The primary outcome was LOS. Cox regression was used to calculate hazard ratios for LOS.
Results
Data from 402 of 412 patients, of whom 199 (49·5 per cent) were allocated to chewing gum, were available for analysis. Some 40 per cent of patients in both groups had laparoscopic surgery, and all study sites used enhanced recovery programmes. Median (i.q.r.) LOS was 7 (5–11) days in both groups (P = 0·962); the hazard ratio for use of gum was 0·94 (95 per cent c.i. 0·77 to 1·15; P = 0·557). Participants allocated to gum had worse quality of life, measured using the EuroQoL 5D‐3L, than controls at 6 and 12 weeks after operation (but not on day 4). They also had more complications graded III or above according to the Dindo–Demartines–Clavien classification (16 versus 6 in the group that received standard care) and deaths (11 versus 0), but none was classed as related to gum. No other differences were observed.
Conclusion
Chewing gum did not alter the return of bowel function or LOS after colorectal resection. Registration number: ISRCTN55784442 (http://www.controlled-trials.com).
No advantage observed</description><subject>Aged</subject><subject>Chewing Gum</subject><subject>Clinical trials</subject><subject>Colectomy</subject><subject>Defecation</subject><subject>Female</subject><subject>Flatulence</subject><subject>Gastrointestinal Motility</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Ileus - prevention & control</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Postoperative Care</subject><subject>Postoperative Complications - classification</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative period</subject><subject>Quality of Life</subject><subject>Randomized Clinical Trial</subject><subject>Single-Blind Method</subject><subject>United Kingdom - epidemiology</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp9UstuFDEQtBCILIEDP4AsceEyxI_x64JEAgmJlocIiKPl9fRsvMyMF3tmQ_L1MdmwAg5c7JK6qlStLoSeUvKSEsIOFqtcADX1PTSjXIqKUanvoxkhRFWUM76HHuW8IoRyIthDtMcUraUyfIbaz25oYh-uocG-C0PwrsNjCuWNLV7HPMY1JDeGDWB_AZdhWOLl1OMNpDxlnMcid6loXQLs2hES9rGLCfxYLBLkAkIcHqMHresyPLn799HX47dfjt5V848np0ev55WvlagrT8BI3TAnFpwaAh6a2tWcNRK8Uy0ztGaa81owTyWjAFTzRhPZOuGMFi3fR6-2vutp0UPjYRiT6-w6hd6lKxtdsH9PhnBhl3FjBdG1kqwYvLgzSPHHBHm0fcgeus4NEKdsqTJKK0mILNTn_1BXcUpDWc9SU45BFJPqvyxlpKJaGV1Yz_7MvQv8-1CFcLAlXIYOrnZzSuyvBtjSAHvbAHt4dn4LiqLaKkIe4edO4dJ3W2IpYb99OLHsfP7m_bH8ZCm_AewLsvY</recordid><startdate>201607</startdate><enddate>201607</enddate><creator>Atkinson, C.</creator><creator>Penfold, C. M.</creator><creator>Ness, A. R.</creator><creator>Longman, R. J.</creator><creator>Thomas, S. J.</creator><creator>Hollingworth, W.</creator><creator>Kandiyali, R.</creator><creator>Leary, S. D.</creator><creator>Lewis, S. J.</creator><general>John Wiley & Sons, Ltd</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201607</creationdate><title>Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection</title><author>Atkinson, C. ; Penfold, C. M. ; Ness, A. R. ; Longman, R. J. ; Thomas, S. J. ; Hollingworth, W. ; Kandiyali, R. ; Leary, S. D. ; Lewis, S. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4754-c0e968d2a5b3190eced4a432d6eca7f29142833452c1621ee183d806fa5a985f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Chewing Gum</topic><topic>Clinical trials</topic><topic>Colectomy</topic><topic>Defecation</topic><topic>Female</topic><topic>Flatulence</topic><topic>Gastrointestinal Motility</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Ileus - prevention & control</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Postoperative Care</topic><topic>Postoperative Complications - classification</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative period</topic><topic>Quality of Life</topic><topic>Randomized Clinical Trial</topic><topic>Single-Blind Method</topic><topic>United Kingdom - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Atkinson, C.</creatorcontrib><creatorcontrib>Penfold, C. M.</creatorcontrib><creatorcontrib>Ness, A. R.</creatorcontrib><creatorcontrib>Longman, R. J.</creatorcontrib><creatorcontrib>Thomas, S. J.</creatorcontrib><creatorcontrib>Hollingworth, W.</creatorcontrib><creatorcontrib>Kandiyali, R.</creatorcontrib><creatorcontrib>Leary, S. D.</creatorcontrib><creatorcontrib>Lewis, S. J.</creatorcontrib><collection>Istex</collection><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Atkinson, C.</au><au>Penfold, C. M.</au><au>Ness, A. R.</au><au>Longman, R. J.</au><au>Thomas, S. J.</au><au>Hollingworth, W.</au><au>Kandiyali, R.</au><au>Leary, S. D.</au><au>Lewis, S. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2016-07</date><risdate>2016</risdate><volume>103</volume><issue>8</issue><spage>962</spage><epage>970</epage><pages>962-970</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background
Chewing gum may stimulate gastrointestinal motility, with beneficial effects on postoperative ileus suggested in small studies. The primary aim of this trial was to determine whether chewing gum reduces length of hospital stay (LOS) after colorectal resection. Secondary aims included examining bowel habit symptoms, complications and healthcare costs.
Methods
This clinical trial allocated patients randomly to standard postoperative care with or without chewing gum (sugar‐free gum for at least 10 min, four times per day on days 1–5) in five UK hospitals. The primary outcome was LOS. Cox regression was used to calculate hazard ratios for LOS.
Results
Data from 402 of 412 patients, of whom 199 (49·5 per cent) were allocated to chewing gum, were available for analysis. Some 40 per cent of patients in both groups had laparoscopic surgery, and all study sites used enhanced recovery programmes. Median (i.q.r.) LOS was 7 (5–11) days in both groups (P = 0·962); the hazard ratio for use of gum was 0·94 (95 per cent c.i. 0·77 to 1·15; P = 0·557). Participants allocated to gum had worse quality of life, measured using the EuroQoL 5D‐3L, than controls at 6 and 12 weeks after operation (but not on day 4). They also had more complications graded III or above according to the Dindo–Demartines–Clavien classification (16 versus 6 in the group that received standard care) and deaths (11 versus 0), but none was classed as related to gum. No other differences were observed.
Conclusion
Chewing gum did not alter the return of bowel function or LOS after colorectal resection. Registration number: ISRCTN55784442 (http://www.controlled-trials.com).
No advantage observed</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>27146793</pmid><doi>10.1002/bjs.10194</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of surgery, 2016-07, Vol.103 (8), p.962-970 |
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| source | MEDLINE; Access via Wiley Online Library; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Aged Chewing Gum Clinical trials Colectomy Defecation Female Flatulence Gastrointestinal Motility Health risk assessment Humans Ileus - prevention & control Length of Stay - statistics & numerical data Male Postoperative Care Postoperative Complications - classification Postoperative Complications - epidemiology Postoperative period Quality of Life Randomized Clinical Trial Single-Blind Method United Kingdom - epidemiology |
| title | Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection |
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