Several small clinical trials have suggested that chewing gum after surgery to remove a part of the colon can enhance intestinal recovery, and some have suggested that this can result in a shortened hospital stay for the patient. Now, a meta-analysis of 5 clinical trials, involving a total of 158 patients, has found that the combined results for the beneficial effect on intestinal recovery of chewing gum reached statistical significance, but those showing a shortening of hospital stay did not.
Unfortunately, the studies are insufficiently powered to identify a significant benefit in the length of hospital stay, comment Sanjay Purkayastha, BSc, MRCS, and colleagues from St. Mary's Hospital, in London, United Kingdom. The report of their meta-analysis is published in the August issue of Archives of Surgery.
Chewing gum is worth studying further, the authors conclude. It is extremely low cost, has no reported adverse effects and, if it can reduce the length of a hospital stay by even 1 day, there would be substantial savings.
"The potential benefits to individual patients, in health economic terms, are such that a well-designed, large-scale, blinded, randomized controlled clinical trial with a placebo arm is warranted to answer the question of whether gum chewing can significantly reduce the length of stay after abdominal surgery or whether it merely represents a placebo effect," they conclude.
The idea of using chewing gum to aid recovery after colon surgery has been discussed in some detail, as previously reported on Medscape.
The potential cost saving, in particular, has garnered much attention. One estimate, based on an outlay of $0.04 per stick of chewing gum, an estimate of 79,219 colectomies per year, and a mean cost of hospital stay of $1500 per day, suggests that if it were to reduce the length of hospital stay by 1 day, this intervention could result in savings of nearly $119 million annually in the United States (Arch Surg. 2006;141:174-176).
Small Numbers of Patients in Trials Carried Out To Date
In each of the trials, sugarless gum was chewed 3 times a day after surgery, and the duration of chewing ranged from 5 to 45 minutes. One of the 5 trials involved patients with colorectal cancer.
Overall results from the meta-analysis showed that chewing gum had a significant effect on reducing the time for the patient to pass flatus (by a mean of more than half a day; P = .005) and the time until the first bowel movement (by a mean of just over 1 day; P = .002). The results also suggest that chewing gum reduced the length of hospital stay by more than 1 day, although this did not reach statistical significance (P = .23).
"We cannot rule out the possibility that the observed reduction was due to chance," the authors write. However, they also suggest that the lack of statistical significance might be due to the small number of patients involved. The analysis of the effect on hospital stay involved only 4 of the trials, and a total of 134 patients. The authors note that to show a statistically significant difference of 1.25 days (at P = .05) between the 2 groups with 80% power, a traditional randomized controlled trial would require 80 patients in each group.
The researchers have disclosed no relevant financial relationships.
Arch Surg. 2008;143:788-793.
Reviewed by Ramaz Mitaishvili, MD
