The effects of coffee vs. Gum chewing after cesarean on bowel functions: a systematic review and network meta-analysis

Study objective: This systematic review and network meta-analysis aimed to compare the effects of coffee consumption and gum chewing on postoperative bowel function recovery in patients undergoing cesarean sections. Design: Systematic review and network meta-analysis of randomized controlled trials. Patients: Patients undergoing cesarean section. Interventions: Coffee consumption and gum chewing for postoperative bowel function recovery. Measurements: The primary outcomes included the time to first defecation, first flatus, and first bowel sound postoperatively. Secondary outcomes comprised the time to first feeling of hunger, time to first toleration of food, length of hospital stay, incidence of complications, and patient satisfaction. Main results: Twenty studies involving 2,876 patients were included. Four studies compared coffee consumption to a control group, while sixteen studies compared gum chewing to a control group. Compared to the control group, the coffee group demonstrated a significant reduction in the time to first defecation (mean difference [95% CI]: − 4.4 [−5.97, − 2.91]; I 2 = 39%; p < 0.00001) and the time to first flatus (mean difference [95% CI]: − 4.59 [−5.67, − 3.51]; I 2 = 48%; p < 0.00001). Similarly, the gum chewing group showed significant reductions compared to the control group in the time to first defecation (mean difference [95% CI]: − 8.04 [−11.49, − 4.58]; I 2 = 98%; p < 0.00001), first flatus (mean difference [95% CI]: − 7.52 [−10.14, − 4.90]; I 2 = 98%; p < 0.00001), and first bowel sound (mean difference [95% CI]: − 4.67 [−7.29, − 2.06]; I 2 = 99%; p < 0.00001). However, network meta-analysis revealed no significant differences between the coffee and gum chewing groups in these three outcomes. Additionally, coffee consumption significantly reduced the time to first toleration of food, whereas gum chewing did not shorten the time to first feeling of hunger or first toleration of food. Compared to the control group, gum chewing, but not coffee consumption, was associated with a shorter postoperative hospital stay. Furthermore, gum chewing reduced the incidence of complications and improved patient satisfaction. Conclusions: Gum chewing is more effective than coffee consumption in promoting postoperative bowel function recovery. However, both interventions are superior to the control group in reducing the time to first defecation and first flatus.