Enhanced Recovery after Planned Gynaecological Surgery: A Study on Gut Motility and Hospital Stay
DOI:
https://doi.org/10.51253/pafmj.v74i6.11982Keywords:
gynaecological surgery, length of hospital stay, post-operative ileus,Abstract
Objective: To evaluate the effectiveness of chewing gum in ameliorating post-operative ileus, reducing hospital stay and improving patient satisfaction after planned gynecological surgery.
Study Design: Quasi-experimental study.
Place and Duration of Study: Combined Military Hospital Kharian, Pakistan from Aug 2022 to Mar 2024.
Methodology: The quasi-experimental study was conducted on a total of 400 patients satisfying the inclusion criteria. Patients were divided into two groups. Group-A had 243 patients while group-B had 157 patients. Patients in the group-A were made to start chewing gum 8 hours post surgery for 15 minutes thrice a day, whereas group-B did not chew any chewing gum. The outcome measures were time to first bowel sounds, passage of flatus, bowel opening, nausea, vomiting, abdominal distension, length of hospital stay and patient satisfaction.
Results: Mean age of patients in groups A and B was 44.0 and 40.0 years respectively. The median time to first audible gut sounds and passage of flatus in group-A were 19.0(17.0-22.0) and 24.0(23.0-28.0) hours versus 23.0(21.0-24.0) and 28.0(27.0-28.5) hours in group-B, p≤0.001. Mean time of first liquid intake and bowel opening in group-A was 28.0(28.0-31.0) and 40.0(37.0-42.0) hours as opposed 31.0 (30.0-42.0) and 44.0(42.0-48.0) hours in group-B, p≤0.001. Mean length of hospital stay in group-A and B was 44.0(42.0-46.0) and 52.0(47.0-56.0) hours with a p-value ≤0.001. There was significantly less nausea and improved patient satisfaction in group-A.
Conclusion: Gum chewing following surgery enhances post-operative Bowel function recovery, patient satisfaction and shortens hospital stay.
Downloads
References
Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part II. Gynecol Oncol 2016; 140: 323-332.
https://doi.org/10.1016/j.ygyno.2015.12.019
O’Neill K, Greenberg S, Cherian M, Gillies R, Daniels K, Roy N, et al. Bellwether procedures for monitoring and planning essential surgical care in low- and middle-income countries: caesarean delivery, laparotomy, and treatment of open Fractures. World J Surg 2016; 40(11): 2611–2619.
https://doi.org/10.1007/s00268-016-3614-y
Ljungqvist O, Scott M, Fearon K. Enhanced recovery after surgery. JAMA Surg 2017; 152(3): 292-298.
https://doi.org/10.1001/jamasurg.2016.4952
Oodit R, Biccard B, Nelson G, Ljungqvist O, Nelson G. ERAS society recommendations for improving perioperative care in low- and middle-income countries through implementation of existing tools and programs: an urgent need for the surgical safety checklist and enhanced recovery after surgery. World J Surg 2021; 45(11): 3246–3248.
https://doi.org/10.1007/s00268-022-06450-y
Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines, Francis N, et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg 2018; 43: 659–695. https://doi.org/10.1007/s00268-018-4844-y
Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G,Altman A, Meyer L, et al. Guidelines for Perioperative care in gynecologic/oncology: enhanced recovery after surgery (ERAS) society recommendations—2019 update. Int J Gynecol Cancer 2019; 29(4): 651–668. https://doi.org/10.1136/ijgc-2019-000356
GlobalSurg Collaborative. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018; 18(5): 516–525. https://doi.org/10.1016/S1473-3099(18)30101-4
Barber EL, Van Le L. Enhanced Recovery Pathways in Gynecology and Gynecologic Oncology. Obstet Gynecol Surv 2015; 70(12): 780-792.
https://doi.org/10.1097/OGX.0000000000000259
Rausa E, Kelly M, Asti E, Aiolfi A, Bonitta D, Winter D,et al. Extended versus conventional thromboprophylaxis after major abdominal and pelvic surgery: systematic review and meta-analysis of randomized clinical trials. Surgery 2018; 164(6): 1234–1240.https://doi.org/10.1016/j.surg.2018.05.028
Weber W, Mujagic E, Zwahlen M, Bundi M, Hoffmann H, Soysal S, et al. Timing of surgical antimicrobial prophylaxis: a phase 3 randomised controlled trial. Lancet Infect Dis 2017; 17(6): 605–614. https://doi.org/10.1016/S1473-3099(17)30176-7
Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H. Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review. F1000Res 2020 13; 9: F1000 Faculty Rev-983.
https://doi.org/10.12688/f1000research.21832.1
Abeles A, Kwasnicki RM, Darzi A. Enhanced recovery after surgery: Current research insights and future direction. World J Gastrointest Surg 2017; 9(2): 37-45.
https://doi.org/10.4240/wjgs.v9.i2.37
Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A, et al. Postoperative ileus: Pathophysiology, incidence, and prevention. J Visc Surg 2016; 153(6): 439-446.
https://doi.org/10.1016/j.jviscsurg.2016.08.010
Amirian I, Gögenur I. Brug af tyggegummi fremmer tarmmotiliteten efter gynækologisk-obstetrisk kirurgi [The use of chewing gum stimulates bowel motility after gynaecological surgery]. Ugeskr Laeger. 2016; 178(14): V02160093. Danish.
Aun A, Summaya S, Amjad SM, Mujeeb A, Khursheed S, Rozina M. Chewing Aid in routine postoperative orders-Does it reduce postoperative ileus after cesarean section? A randomized Control Trial. J Liaquat Uni Med Health Sci 2019; 18(02): 109-112
Badireddy M, Mudipalli VR. Deep Venous Thrombosis Prophylaxis. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2024.
Ulasi IB, Afuwape OO, Ayandipo OO, Fakoya A, Irabor DO. The Effects of Combined Gum-chewing and Parenteral Metoclopramide on the Duration of Postoperative Ileus After Abdominal Surgery. J West Afr Coll Surg 2023; 13(4): 46-57. https://doi.org/10.4103/jwas.jwas_38_23
Yin YN, Xie H, Ren JH, Jiang NJ, Dai L. The impact of gum-chewing on postoperative ileus following gynecological cancer surgery: A systematic review and meta-analysis of randomized controlled trials. Front Oncol 2023 ; 17; 12:1059924.
https://doi.org/10.3389/fonc.2022.1059924
Bowe R, Irwin R, Browne G, Harbison M, Gallen S, Yore PJ, et al. Chewing Gum for Prevention of Nausea and Vomiting After Elective Caesarean Section: a Pilot Randomised Controlled Trial. SN Compr Clin Med 2022;4(1):257.
https://doi.org/10.1007/s42399-022-01332-9
Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part II. Gynecol Oncol 2016;140(2):323-332.
https://doi.org/10.1016/j.ygyno.2015.12.019
Nanthiphatthanachai A, Insin P. Effect of Chewing Gum on Gastrointestinal Function Recovery After Surgery of Gynecological Cancer Patients at Rajavithi Hospital: A Randomized Controlled Trial. Asian Pac J Cancer Prev 2020 1;21(3):761-770.
https://doi.org/10.31557/apjcp.2020.21.3.761
Park SH, Choi MS. Meta-Analysis of the Effect of Gum Chewing After Gynecologic Surgery. J Obstet Gynecol Neonatal Nurs 2018;47(3):362-370.
https://doi.org/10.1016/j.jogn.2018.01.011
Xu C, Peng J, Liu S, Qi DY. Effect of chewing gum on gastrointestinal function after gynecological surgery: A systematic literature review and meta-analysis. J Obstet Gynaecol Res 2018;44(5):936-943.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Uzma Saleem, Nadia Arif
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
