Meta-analyses
Coffee to go? The effect of coffee on resolution of ileus following abdominal surgery: A systematic review and meta-analysis of randomised controlled trials
Introduction
Postoperative ileus (POI) is the temporary delay of gastrointestinal motility after surgery, characterised by abdominal discomfort, anorexia, nausea, vomiting, lack of bowel sounds, and the absence of flatus or stool [1], [2]. The aetiology of POI is complex but is thought to be the result of interplay between local trauma and the systemic stress response to surgery. A number of factors are thought to affect to the development of POI including: preoperative mechanical bowel preparation, handling of the intestines during surgery, surgical trauma, fluid overload, type of anaesthesia, type of analgesia, BMI, age, sex and ethnicity [1].
The incidence of POI following major abdominal surgery is between 8.5% and 24% [3], [4] with resolution after 2–7 days [1], [5]. POI is a considerable cause of postoperative morbidity; complications include fluid and electrolyte imbalance, immunocompromise, pneumonia, venous thromboembolism and poor wound healing [1], [2]. POI increases length of hospital stay and cost of treatment [3], [4].
Common preventative interventions include avoidance of preoperative bowel preparation, use of minimally-invasive surgery, epidural analgesia, early mobilisation, and early oral nutritional intake [1]. Chewing gum and alvimopan, a peripheral μ-opioid receptor antagonist, aid the resolution of ileus, as recently identified by Cochrane reviews [6], [7]. Coffee may also stimulate bowel motility to aid resolution of POI.
A number of small randomised controlled trials (RCTs) have identified positive effects of caffeinated and decaffeinated coffee on postoperative recovery of bowel function [8], [9], but effects were not consistent across all outcomes reported. Anecdotally, coffee is associated with gastroesophageal reflux symptoms [10]; effects on lower oesophageal sphincter tone and gastric emptying are unclear [11].
In the present systematic review and meta-analysis, we aim to complete an integrative review of the safety and efficacy of postoperative coffee consumption to aid resolution of ileus after abdominal surgery. Considering the large numbers of abdominal surgeries performed annually, postoperative coffee consumption may be an inexpensive, widely-available and well-tolerated intervention to speed the recovery of gastrointestinal function postoperatively. Reductions in POI, ileus-related complications, and hospital stay would reduce morbidity and be economically beneficial for health organisations.
Section snippets
Methods
The protocol for this systematic review was registered on PROSPERO (York, UK), registration number CRD42018087962, and can be accessed at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087962 .
Study selection
Our search strategy retrieved 2757 records. 1765 remained after removal of duplicates. 1731 results were excluded on title and abstract and 34 full-text records were assessed for eligibility. 7 studies (11 records) were eligible and included in the qualitative synthesis, all of which were published in English. Six were complete publications, of which two were registered on clinical trial databases. One (Hasler-Gehrer et al., 2017) was an abstract that was also registered on a clinical trial
Estimated data sensitivity analysis
We estimated mean or standard deviation for three studies [8], [17], [19], presented in Table 1. Pooled estimates for all continuous outcomes were very similar to the original pooled estimates when estimated data was excluded from analysis. A trend towards slightly smaller effect sizes is likely due to the steep reduction in number of included studies for some outcomes, resulting in heavy relative weighting of Müller et al. (2012). Confidence intervals were markedly larger for time to first
Discussion
This systematic review and meta-analysis demonstrate that coffee has a small to moderate effect in shortening POI following major colorectal and gynaecological abdominal surgery. Time to first defecation, first bowel sound or sensation of bowel movement, and first tolerance of solid food were reduced with postoperative coffee consumption. There was little effect on time to first flatus with marked inter-study heterogeneity between otherwise-similar RCTs. This was possibly due to challenges
Implications for practice
POI is a common cause of postoperative morbidity. We found low-to-moderate quality evidence suggesting a decrease in time to recovery of bowel function after gynaecological and colorectal abdominal surgery, and no evidence to suggest an increased rate of complications or adverse effects with coffee consumption. Coffee is a simple, cheap, and well-tolerated intervention to reduce POI. Therefore, we recommend that [1] patients are routinely given access to unsweetened caffeinated or decaffeinated
Details of ethics approval
None required.
Contribution to authorship
HLC conceived the study idea, designed and performed the literature search, extracted data, assessed study quality, performed statistical analysis and wrote the initial draft of the article. BE performed the literature search, extracted data and assessed study quality. JFC settled disagreements regarding bias scoring. JFC and SB contributed to the design of the study and supervised the study. All authors contributed to data interpretation and performed critical review and editing of the article.
Disclosure of interest
The authors declare no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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