title: The Use of Chewing Gum Postoperatively in Pediatric Scoliosis Patients Facilitates an Earlier Return to Normal Bowel Function.
abstract: OBJECTIVE
  In surgical correction of scoliosis in pediatric patients, gastrointestinal complications including postoperative ileus can result in extended hospital stays, poorer pain management, slower progression with physical therapy, and overall decreased patient satisfaction. In patients undergoing gastrointestinal, gynecological, and urological surgery, gum chewing has been shown to reduce time to flatus and passage of feces. The authors hypothesized that chewing gum could also speed return to normal bowel function in pediatric patients undergoing surgical correction of scoliosis.
  
  
  METHODS
  The researchers obtained institutional review board approval for a prospective, randomized, controlled trial. Eligible patients included all adolescent idiopathic scoliosis patients undergoing posterior spinal fusion. Exclusion criteria included previous gastrointestinal surgery or preexisting gastrointestinal disease. Patients were randomized by coin flip. The treatment group chewed sugar-free bubble gum 5 times a day for 20 to 30 minutes beginning on postoperative day 1; the control group did not chew gum. Patients were asked a series of questions regarding subjective gastrointestinal symptoms each day. Time to flatus and first passage of feces were recorded as indicators of return to normal bowel function. Normality of data was assessed using normal probability plots.
  
  
  RESULTS
  A total of 83 patients completed the study (69 females and 14 males; mean age, 14.4 years). Of the 42 patients in the chewing gum group, 8 elected to stop chewing gum regularly before discharge for to a variety of reasons. Patients who chewed gum experienced first bowel movement on average 145.9 hours after surgery, 30.9 hours before those who did not chew gum (p = .04). Gum-chewing patients first experienced flatus an average of 55.2 hours after surgery, compared with 62.3 hours for controls. This trend did not reach statistical significance (p = .12). No difference was noted in duration of hospital stay, medications administered as required, or subjective symptoms.
  
  
  CONCLUSIONS
  Chewing gum after posterior spinal fusion for scoliosis is safe and may speed return of normal bowel function. Chewing gum after surgical correction of scoliosis facilitates an earlier return to normal bowel function, which may improve patient satisfaction in the early postoperative period.
authors.affiliation: Division of Orthopaedic Surgery, University of Alabama, Birmingham, 502 Boshell Building, 1808 7th Avenue South, Birmingham, AL 35294-0012, USA.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Jennings
authors.affiliation: Division of Orthopaedic Surgery, University of Alabama, Birmingham, 502 Boshell Building, 1808 7th Avenue South, Birmingham, AL 35294-0012, USA; Children's of Alabama, 1600 7th Avenue South, Birmingham, AL 35233, USA.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Doyle
authors.affiliation: Division of Orthopaedic Surgery, University of Alabama, Birmingham, 502 Boshell Building, 1808 7th Avenue South, Birmingham, AL 35294-0012, USA; Children's of Alabama, 1600 7th Avenue South, Birmingham, AL 35233, USA.
authors.forename: Shawn R
authors.initials: SR
authors.lastname: Gilbert
authors.affiliation: Division of Orthopaedic Surgery, University of Alabama, Birmingham, 502 Boshell Building, 1808 7th Avenue South, Birmingham, AL 35294-0012, USA; Children's of Alabama, 1600 7th Avenue South, Birmingham, AL 35233, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Conklin
authors.affiliation: Division of Orthopaedic Surgery, University of Alabama, Birmingham, 502 Boshell Building, 1808 7th Avenue South, Birmingham, AL 35294-0012, USA; Children's of Alabama, 1600 7th Avenue South, Birmingham, AL 35233, USA. Electronic address: jkhoury@uabmc.edu.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Khoury
keywords: Adolescent; Complications; Gum; Scoliosis