Effect of chewing gum on bowel motility in post operative patients following abdominal surgery: A clinical outcome based study
One of the problems in the treatment of patients after surgery on the abdominal organs is the restoration of intestinal peristalsis. Violation of intestinal motility in the early postoperative period is considered the cause of various gastrointestinal tract disorders. Even in patients operated on the pelvic organs, the retroperitoneal space, and the spine, nausea, vomiting, and a lack of appetite are often observed, as a delay in the passage of gases and stools for several days. Nevertheless, impaired peristalsis in the immediate postoperative period is typical for abdominal surgery and occurs in at least 90% of patients (Kumar et al., 2018). There is also an apparent connection between the function of the gastrointestinal tract, on the one hand, and the course and prognosis of the disease, on the other. The severity of intestinal peristalsis disorders is proportional to the severity of the pathological process. In turn, complications after abdominal surgery associated with intestinal peristalsis affect the organization. It increases the burden on medical personnel and prolongs the presence of patients with impaired intestinal peristalsis. As a result, the medical institution’s throughput decreases, and the overall indicators of its effectiveness deteriorate.
In this regard, measures aimed at improving intestinal motility in patients undergoing abdominal surgery are crucial. Kumar et al. (2018) believe that chewing gum can effectively solve this problem. Chewing gum to restore intestinal motility after an appendectomy, cesarean section, and colorectal and urological operations helps reduce paresis and earlier gas. Thus, the evidence-based practice PICO question is: Does chewing gum (I) compared with non-chewing gum (C) in patients undergoing abdominal surgery (P) affect postoperative intestinal motility (O)?
Purpose of the Research Article
The article aims to evaluate the effectiveness of chewing gum to improve intestinal motility in patients after abdominal surgery. The authors compare how much bowel motility recovery varies with and without chewing gum in abdominal surgery patients.
Research Methodology
This study is a randomized, controlled, and experimental clinical study of 200 patients, 100 of whom used chewing gum after abdominal surgery and 100 of whom did not. The author identified inclusion criteria and exclusion criteria. Inclusion criteria are age over 18 years of age, good consciousness, willingness to chew, undergoing abdominal surgery, any gender, any BMI, and informed consent. Exclusion criteria include age less than 18 years of age, loss of consciousness after surgery, inability to chew, and several diagnoses, including pyloric obstruction, remnant gastric cancer, muscle, and neurological disorders, and severe water and electrolyte disturbances.
Level of Evidence
According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, this source meets evidence level I since it is an experimental study.
Data Analysis
The data obtained were analyzed using the SPSS statistical data processing software (version 19.0). Continuous variables, including age, duration of surgery, use of analgesics, and time to first gas and bowel movements, were presented as the mean, adjusted for standard deviation. Categorical variables such as sex, ASA score, comorbidities, postoperative complications, pain score, and nausea and vomiting scores were expressed as frequencies. The Student’s t-test was used to compare the mean values of continuous variables with normal distribution. In turn, the Mann-Whitney U test was used for variables with a nonparametric distribution. Categorical variables were compared using the χ2 test. The Yate correction was used for small samples.
Ethical Consideration
The study involved only patients who gave informed consent. Moreover, the study was approved by the institutional ethics committee.
Quality Rating
According to the JHNEBP model, the study is of high quality. It has consistent and generalizable results, provides a sufficient sample size, draws relevant conclusions, and provides a comprehensive literature review with detailed references to scientific evidence.
Conclusions
The authors found that chewing gum has a significant effect on intestinal motility since the sound of the intestines, the release of the first gases, and the first bowel movement appear much earlier in patients using it after abdominal surgery than in patients not using it. Kumar et al. (2018) found that chewing gum is a safe method of stimulating intestinal motility regardless of the type of surgery, including routine, emergency, traumatic, pathological, gastric, and small bowel ones, in which there is a different duration before the first manifestations of intestinal motility. Moreover, it was found that patient’s hospital stay using chewing gum was significantly less than that of patients who not using it. This research helps to get a positive answer to the EBP question. Thus, chewing gum, compared with its non-use in patients undergoing abdominal surgery, improves intestinal peristalsis.
Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons
Purpose of the Article
The purpose of this article is to provide information on what decisions can be made to speed up recovery from colon and rectal surgery.
Type of Evidence
This non-research article is a clinical practice guideline.
Level of Evidence
According to the JHNEBP model, this study has evidence level IV.
Quality Rating
According to the JHNEBP model, the quality rating of the submitted article is high, as the material was presented by experts in the field of colon and rectal surgery who are members of the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Moreover, the guideline presents consistent results with sufficient well-designed studies, definitive conclusions, overall scientific strength, and the quality of the 371 studies included. It is noteworthy that the guideline has been developed over the past five years.
Author’s Recommendations
Although the guideline focuses on various aspects of accelerated recovery from colon and rectal surgery, the authors focus on sham feeding, including chewing gum in patients undergoing abdominal surgery. Thus, the authors note that chewing sugar-free gum for at least 10 minutes 3-4 times a day improves gastrointestinal recovery and may be associated with a reduction in the length of hospital stay. Notably, the grade of the recommendation is rated strong as it is based on high-quality evidence.
Practice Change
Thus, chewing gum for patients undergoing abdominal surgery can effectively improve intestinal motility, which promotes faster recovery. Accordingly, this method should be more widely included in the rehabilitation of patients who have undergone abdominal surgery. The main stakeholders to support the practice change recommendation are clinic managers, clinic staff, and patients. Clinic managers need to help employees embrace the new changes. Thus, managers must ensure that employees have the knowledge and tools to carry them out. To do this, managers can organize training and lectures for staff, where employees can expand their knowledge about the rehabilitation of patients after abdominal surgery, including chewing gum. It is also essential for clinic staff to improve their knowledge and study clinical guidelines and scientific articles that offer promising strategies for providing high-quality care for patients after abdominal surgery. In turn, patients should follow the instructions of doctors and nurses and not forget to chew gum.
One barrier to increased use of chewing gum to improve intestinal motility may be patient reluctance to follow this recommendation of caregivers. Patients may forget to do this or not see the point in it. In this regard, the clinic staff, as well as clinic managers, should improve communication with patients. A detailed explanation of the benefits of chewing gum after abdominal surgery, reference to relevant studies, and the use of stands demonstrating the importance of this method will help in this. Therefore, a specific measurement of the use of chewing gum to improve intestinal motility in patients undergoing abdominal surgery is a faster time to detect first bowel sounds, first gas, and first bowel movement than in patients not using it.
References
Carmichael, J.C., Keller, D.S., Baldini, G., Bordeianou, L., Weiss, E., Lee, L., Boutros, M., McClane, J., Feldman, L.S. & Steele, S.R. (2017). Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Diseases of the Colon & Rectum, 60(8), 761-784.
Kumar, A., Kumari, R., Kumar, S. & Raj, P. (2018). Effect of chewing gum on bowel motility in post operative patients following abdominal surgery: A clinical outcome based study. International Surgery Journal, 5(8), 2808-2812. Web.