I was in the top set for maths at school, which the teacher who had us didn’t like at all. At report card time I got a 4 for effort, usually a 3 for behaviour and had some of the best marks so she couldn’t get rid of me (a 4 was the worst). This really pissed off Mrs Mitchell, who gave me endless punishment exercises.
I must not eat in class. 100 times.
I must not talk constantly in class. 100 times.
Chewing gum is a disgusting habit. 100 times.
This month’s British Journal of Surgery suggests otherwise, although why we are still calling it that I don’t know as almost every article this month is from the Netherlands. Lots of smart people over there obviously, with nice workloads that give them time for this sort of stuff. (See van der Heijkant et al. Randomized clinical trial of the effect of chewing gum on postoperative ileus and inflammation in colorectal surgery. British Journal of Surgery 2015;102:202-211)
Back to the chewing gum, this has long been one part of the ERAS program (you can read my thoughts on that here) and had previously been shown to be effective in reducing post operative ileus. This group have gone one step further and evaluated the effect on the inflammatory processes post operatively. They have looked only at elective colorectal surgery, including all sorts of colonic and rectal resections.
What is so very interesting about this study is that the mean length of stay was 9 days in one arm and 14 in the other (a non-significant difference when they used a Kaplan-Meier) so they decided to use the wrong analytical tool, a two sample T test (which they admit that they should not have used as the data wasn’t normally distributed but they adjusted that to make it fit) which is significant yet utterly irrelevant as it was the wrong test? There’s something that doesn’t quite seem right about this but my stats are not up to scratch to say what that is; it does seem odd that a 5 day difference is non-significant.
A mean 14 day stay…in the fast tracking, ERAS loving, cycling to hospital and home again land of miracles? It’s all rather different to the home on day 4 following anterior resection shite that gets banded about by the Dutch informing us how stupid we are to not give everyone steak and chips on day 2 and get a nurse to ring them at home the next day to check they aren’t dead.
Also thrown in as an almost aside is that they have a 50% colostomy rate, that’s pretty high for a mixed group of resections. They have faffed about with a lot of extraneous experiments (someone’s PhD obviously, see should I do a higher degree?) that are not particularly interesting and I won’t bore you with here.
What is most important in this paper is that chewing gum post operatively makes you better quicker, passing wind and stool quicker, home sooner and much less likely to have to go back to theatre (5% versus 18%). There were the same amount of little complications (Clavien-Dindo 1’s, like wound a bit red) and massive ones (Clavien-Dindo 4 and 5’s, life threatening or death).
Back to theatre complications (Clavien-Dindo 3) are the ones we really hate, the patient hates, the anaesthetist hates and really sets patients back and makes them feel dissatisfied. Complications are my life’s obsession and if a drug existed that could have an effect as fantastic as chewing gum does, it would make someone a millionaire.
Nobody has looked at the use of chewing gum in emergency surgery as yet, but I would assume the results are the same. I may have to look into this if I can motivate myself to investigate it, I need a student who wants a project..
In the meantime, if you’re having an operation then bring a few packets of chewing gum with you.