Authors:
Dr.
Yasser
Debakey
MD
1✉
Phone+20-100-134-0579
Emaily.eldebakey@cu.edu.eg
Ahmed
Kilany
2
Phone0009-0003-5667-5234 Phone: +201002509460
EmailAhmedkilany_2003@yahoo.com
Ahmed
Refaat
3
Phone0009-0009-3101-5268 Phone: +20 103 033 3363
EmailDrahmadref3at@gmail.com
Amr Abdallah Youssef
Nofal
MD
1
EmailAmr.nofal@cu.edu.eg
1
Department of Surgical Oncology
National Cancer Institute (NCI), Cairo University
11796
Cairo
Egypt
2
Consultant of general surgery at Sahel teaching hospital
ministry of health
11796
Cairo
Egypt
3
Faculty of Medicine
Cairo University
11796
Cairo
Egypt
Dr. Yasser Debakey, MD (Corresponding Author)
Department of Surgical Oncology ,National Cancer Institute (NCI),Cairo University, Cairo, Egypt ,11796
Email: y.eldebakey@cu.edu.eg
Phone: +20-100- 134–0579
ORCID Number :0000-0002-6672-6336
Ahmed Kilany
Consultant of general surgery at Sahel teaching hospital, ministry of health, Cairo, Egypt, 11796
Email: Ahmedkilany_2003@yahoo.com
ORCID Number: 0009-0003-5667-5234
Phone : +201002509460
Ahmed Refaat
Associate professor of General Surgery Faculty of Medicine Cairo University, Cairo, Egypt, 11796
Email: Drahmadref3at@gmail.com
ORCID Number: 0009-0009-3101-5268
Phone : +20 103 033 3363
Dr. Amr Abdallah Youssef Nofal, MD
Department of Surgical Oncology ,National Cancer Institute (NCI) ,Cairo University, Cairo, Egypt 11796
Email: Amr.nofal@cu.edu.eg
ORCID Number: 0009-0000-5890-0261
A
Abstract
Background
A
Postoperative ileus remains a common issue after colorectal surgery, even with minimally invasive techniques and enhanced recovery after surgery (ERAS) pathways. Simple, low-cost oral interventions such as coffee may help accelerate bowel recovery (
1–
3).
Objective
To compare the effect of standardized postoperative coffee intake versus fresh orange juice on bowel recovery after elective laparoscopic colorectal resection.
Methods
A
A
In this multicenter randomized controlled trial, 476 adults undergoing elective laparoscopic colorectal resection with primary anastomosis were randomized 1:1 to receive either black coffee or fresh orange juice (150 mL three times daily) starting on postoperative day (POD) 1 for two days. All patients were managed within ERAS-aligned pathways. The primary endpoint was time to first bowel movement. Secondary endpoints included time to first flatus, number of bowel movements until discharge, laxative use, postoperative nasogastric tube insertion, length of hospital stay (LOS), and postoperative complications. Analyses followed an intention-to-treat approach with a per-protocol sensitivity analysis (
4,
5).
Results
Of 476 randomized patients (238 coffee, 238 orange juice), baseline and operative characteristics were comparable. Coffee significantly shortened time to first bowel movement (median 47.5 vs 73 h; p < 0.001) and time to first flatus (median 23 vs 36 h; p < 0.001), and reduced LOS (mean 3.16 vs 5.10 d; p < 0.001). Findings were consistent in the per-protocol cohort. Rates of postoperative ileus, surgical site infection, reoperation, readmission, and anastomotic leakage (grade A/B) were low and similar between groups.
Conclusion
Standardized postoperative coffee intake within an ERAS framework significantly accelerates bowel recovery and shortens LOS after laparoscopic colorectal surgery compared with fresh orange juice, without increasing complications. Coffee is a simple, safe, and inexpensive adjunct that may be incorporated into ERAS protocols for colorectal surgery.
Keywords:
Postoperative Ileus
Enhanced Recovery After Surgery
Laparoscopic Colorectal Surgery, Coffee, Gastrointestinal Motility,
Randomized Controlled Trial
A
A
Introduction
Postoperative ileus (POI) remains a frequent and frustrating challenge after colorectal surgery, even as minimally invasive techniques and structured ERAS pathways have become widely adopted (1, 2). Transient impairment of gastrointestinal motility delays oral intake, increases patient discomfort, prolongs hospital stay, and contributes to respiratory, thromboembolic, and wound complications (3, 4). Although ERAS programs incorporating laparoscopic surgery, opioid-sparing analgesia, early mobilization, and early feeding have reduced the incidence and duration of POI, a substantial proportion of patients still experience delayed bowel recovery (5–7).
There is therefore continuing interest in simple, safe, and inexpensive measures that can be integrated into ERAS care bundles. Coffee is one such candidate. Early physiological studies by Brown et al. and Rao et al. demonstrated that coffee, whether caffeinated or decaffeinated, induces colonic motor activity within minutes of ingestion, with contraction patterns comparable to those triggered by a meal (8, 9). These effects appear to be mediated through neurohormonal pathways, including increased secretion of gastrin and cholecystokinin and activation of cholinergic reflexes, rather than caffeine content alone(8–10).
On this physiological background, several randomized trials evaluated coffee as a means to hasten postoperative bowel recovery. Müller et al. reported shorter time to flatus and bowel movement in patients receiving coffee compared with warm water after colectomy, although their cohort included mainly open procedures (11). Dulskas et al. observed similar trends after laparoscopic colectomy, but their study was underpowered to detect statistically significant differences (12). More recently, Hasler‑Gehrer and colleagues performed a randomized trial comparing coffee with tea after laparoscopic colorectal surgery and showed earlier bowel function in the coffee group; however, differences in LOS did not reach significance, possibly because of very short baseline stays within a well‑established ERAS program (13).
Two contemporary meta‑analyses synthesized these data. Zizzo et al. (2024) and Vaghiri et al. (2024) both concluded that postoperative coffee intake accelerates bowel recovery and may modestly reduce LOS after colorectal and other abdominal operations (1, 2). However, most of the included trials were small, single‑center studies with heterogeneous comparators such as warm water or tea, and few were conducted in strictly standardized laparoscopic ERAS settings.
A
In daily clinical practice, fresh orange juice is frequently provided to postoperative patients as a source of fluids, calories, and micronutrients. Despite this, the specific effect of orange juice on bowel recovery has not been rigorously evaluated, and it has never been directly compared with coffee in a randomized trial. This represents an important knowledge gap, particularly in institutions where orange juice is routinely offered as part of early oral intake.
The present multicenter randomized controlled trial was designed to address this gap. We compared standardized postoperative coffee intake with fresh orange juice in patients undergoing elective laparoscopic colorectal resection managed within an ERAS framework at three tertiary surgical centers. We hypothesized that coffee would accelerate bowel recovery and shorten LOS compared with orange juice, without increasing postoperative complications.
Methods
Study Design and Setting
A
This was a prospective, multicenter, parallel‑group randomized controlled trial conducted at three major surgical centers in Egypt: the National Cancer Institute, Cairo University; Dar Al Fouad Hospitals (6th of October and Nasr City branches); and Al Salam International Hospital, Cairo.
A
The study was approved by the Institutional Review Board of the National Cancer Institute, Cairo University (Approval No. 2110‑510‑012) and registered at ClinicalTrials.gov (NCT05167890). The trial commenced immediately after IRB approval in October 2021 and continued through August 2025, ending two months prior to manuscript preparation.
A
A
All patients provided written informed consent before enrollment, in accordance with the Declaration of Helsinki
Eligibility Criteria
Adults (≥ 18 years) scheduled for elective laparoscopic colorectal resection with primary anastomosis were eligible. Indications included benign and malignant diseases of the colon and rectum. Key exclusion criteria were emergency surgery, planned permanent stoma without an anastomosis, pre‑existing bowel obstruction or ileus, prior pelvic radiotherapy, severe hepatic or renal impairment, known intolerance or allergy to coffee or citrus fruits, impaired consciousness or inability to consent, and use of medications with major effects on gut motility that could not be discontinued. Conversion from laparoscopy to open surgery did not mandate exclusion and such patients remained in the analysis.
Randomization and Allocation Concealment
Randomization was performed in a 1:1 ratio using a computer‑generated sequence with variable block sizes. Allocation was concealed in sequentially numbered, opaque, sealed envelopes prepared by an investigator not involved in perioperative management. Because of the nature of the intervention, blinding of patients and clinical staff was not feasible. Data collection and statistical analysis, however, were undertaken by investigators who were not involved in daily postoperative care.
Perioperative ERAS Protocol
Perioperative management followed institutional ERAS‑aligned pathways at all centers. Key elements included laparoscopic approach whenever feasible, standardized anesthesia, opioid‑sparing multimodal analgesia, early mobilization, and early oral intake as tolerated. Nasogastric tubes were not left in place routinely; postoperative NGT insertion was reserved for persistent vomiting or suspected ileus. Prophylactic laxatives were not routinely prescribed; rescue oral laxatives were introduced at the discretion of the treating surgeon, typically if no bowel movement occurred by POD 3–4.
Intervention: Coffee and Orange Juice Protocol
Beginning on POD 1, patients in the coffee group received 150 mL of unsweetened black coffee three times daily (morning, afternoon, evening) for two consecutive postoperative days, in addition to free fluids and the regular hospital diet. Patients in the orange juice group received 150 mL of freshly squeezed orange juice at the same time points and for the same duration. Nursing staff provided the study drinks and recorded whether each scheduled dose was fully consumed. Consumption of other caffeinated beverages was discouraged during POD 1–2.
Outcomes
The primary endpoint was time from the end of surgery to first bowel movement, recorded in hours. Secondary endpoints were time to first flatus, number of bowel movements until discharge, use of any rescue laxative (yes/no), postoperative NGT insertion (yes/no), LOS (days), and postoperative complications including POI, SSI, chest infection, urinary retention, reoperation, 30‑day readmission, and 30‑day mortality. Anastomotic leakage was defined clinically and/or radiologically and graded A–C according to the International Study Group of Rectal Cancer (14).
Statistical Analysis
The primary analysis followed the intention‑to‑treat principle, including all randomized patients in the groups to which they were allocated. A per‑protocol analysis, restricted to patients with ≥ 80% adherence to the allocated drink schedule, was performed as a sensitivity analysis. Continuous variables are reported as mean ± standard deviation or median (range) and compared using the Student t test or Mann–Whitney U test, as appropriate. Categorical variables are expressed as counts and percentages and compared using chi‑square or Fisher exact tests. A two‑sided p value < 0.05 was considered statistically significant.
Results
Patient Screening and Enrollment
A total of 510 patients were assessed for eligibility, of whom 476 were randomized (238 to coffee and 238 to orange juice).
A
The main reasons for exclusion were failure to meet inclusion criteria or refusal to participate. All randomized patients were included in the intention‑to‑treat analysis. In the per‑protocol analysis, 207 patients in the coffee group and 204 in the orange juice group achieved ≥ 80% adherence to the allocated drink schedule.
Baseline demographic and clinical characteristics were well balanced between groups. Mean age, BMI, prevalence of smoking, and major comorbidities such as diabetes, hypertension, and cardiac or pulmonary disease did not differ significantly (Table 1).
Table 1
Preoperative patient characteristics
|
Variable
|
Coffee (n = 238)
|
Orange (n = 238)
|
p
|
|
Age (y), mean ± SD
|
54.8 ± 20.8
|
57.6 ± 20.2
|
0.1396
|
|
Smoker
|
67 (28.2%)
|
47 (19.7%)
|
0.0317
|
|
BMI, mean ± SD
|
27.94 ± 4.00
|
28.09 ± 3.87
|
0.6881
|
|
Pulmonary disease
|
24 (10.1%)
|
19 (8.0%)
|
0.4240
|
|
Renal disease
|
13 (5.5%)
|
18 (7.6%)
|
0.3530
|
|
Diabetes mellitus
|
79 (33.2%)
|
78 (32.8%)
|
0.9223
|
|
Hypertension
|
97 (40.8%)
|
99 (41.6%)
|
0.8522
|
|
Cardiac disease
|
25 (10.5%)
|
30 (12.6%)
|
0.4734
|
|
ASA grade, mean
|
1.66
|
1.61
|
0.2526
|
Operative Characteristics
Operative data, including conversion rates, duration of surgery, blood loss, and transfusion requirements, were also comparable (Table 2).
Table 2
|
Variable
|
Coffee (n = 238)
|
Orange (n = 238)
|
p
|
|
Converted to open
|
38 (15.96%)
|
47 (19.75%)
|
0.2814
|
|
Duration of operation (min)
|
195.7 ± 49.2
|
195.9 ± 48.6
|
0.9731
|
|
Blood loss (mL)
|
129.1 ± 47.6
|
134.8 ± 49.1
|
0.1948
|
|
Blood transfusion (bags)
|
0.097
|
0.063
|
0.1761
|
Adherence to the Intervention
Compliance with the allocated beverages was high in both groups but slightly higher in the coffee group, with 93–96% of scheduled doses consumed on POD 1–2 compared with 84–87% in the orange juice group (Table 3)
Table 3
Postoperative compliance (POD 1–2)
|
Variable
|
Coffee (n = 238)
|
Orange (n = 238)
|
p
|
|
POD 1 Morning
|
222 (93.3%)
|
200 (84.0%)
|
0.0015
|
|
POD 1 Afternoon
|
222 (93.3%)
|
200 (84.0%)
|
0.0015
|
|
POD 1 Evening
|
223 (93.7%)
|
204 (85.7%)
|
0.0042
|
|
POD 2 Morning
|
222 (93.3%)
|
208 (87.4%)
|
0.0299
|
|
POD 2 Afternoon
|
224 (94.1%)
|
208 (87.4%)
|
0.0113
|
|
POD 2 Evening
|
228 (95.8%)
|
201 (84.5%)
|
< 0.0001
|
Outcomes
Coffee intake was associated with a markedly faster return of bowel function. Median time to first bowel movement was 47.5 hours in the coffee group versus 73 hours in the orange juice group (p < 0.001). Time to first flatus was similarly shorter (23 vs 36 hours; p < 0.001). Patients in the coffee group also had a slightly higher number of bowel movements before discharge, reflecting more sustained activity of the colon.
LOS was significantly reduced in the coffee arm, with a mean of 3.16 days compared with 5.10 days in the orange juice arm (p < 0.001). Use of rescue laxatives and postoperative NGT insertion was infrequent and did not differ in a clinically meaningful way between groups. Overall postoperative morbidity was low and similar, including rates of POI, SSI, chest infection, urinary retention, reoperation, and 30‑day readmission (Table 4).
Table 4
Postoperative outcomes (ITT)
|
Outcome
|
Coffee (n = 238)
|
Orange (n = 238)
|
p
|
|
Time to first bowel movement (median, h)
|
47.5
|
73
|
< 0.0001
|
|
Time to first bowel movement (mean, h)
|
47.1
|
72.6
|
< 0.0001
|
|
Time to first flatus (median, h)
|
23
|
36
|
< 0.0001
|
|
Time to first flatus (mean, h)
|
23.6
|
35.6
|
< 0.0001
|
|
Bowel movements until discharge (mean)
|
5.16
|
4.17
|
—
|
|
Use of any laxative
|
40 (16.8%)
|
29 (12.2%)
|
0.0016
|
|
Postoperative NGT insertion
|
9 (3.8%)
|
14 (5.9%)
|
0.2088
|
|
Length of hospital stay (median, d)
|
3
|
5
|
< 0.0001
|
|
SSI
|
8 (3.4%)
|
15 (6.3%)
|
0.0924
|
|
Ileus
|
5 (2.1%)
|
9 (3.8%)
|
0.2779
|
|
Reoperation
|
1 (0.4%)
|
3 (1.3%)
|
0.3153
|
|
Readmission 30 days
|
3 (1.3%)
|
3 (1.3%)
|
1.0000
|
|
Anastomotic leak
|
12 (5.0%)
|
15 (6.3%)
|
0.5654
|
Anastomotic leakage occurred in 12 patients (5.0%) in the coffee group and 15 patients (6.3%) in the orange juice group; all leaks were grade A or B and there were no grade C leaks requiring re‑intervention. The per‑protocol analysis yielded results consistent with the intention‑to‑treat analysis, with similar relative differences between groups (Table 5).
Table 5
Postoperative Outcomes — Per-Protocol Analysis (Compliance ≥ 80%)
|
Outcome
|
Coffee (PP)
|
Orange (PP)
|
|
Time to first bowel movement (median, h)
|
48
|
73
|
|
Time to first bowel movement (mean, h)
|
47.2
|
72.6
|
|
Time to first flatus (median, h)
|
23
|
36
|
|
Time to first flatus (mean, h)
|
23.4
|
35.4
|
|
Bowel movements until discharge (mean)
|
5.10
|
4.14
|
|
Use of any laxative, n (%)
|
37 (17.9%)
|
49 (24.0%)
|
|
Postoperative NGT insertion, n (%)
|
9 (4.3%)
|
14 (6.9%)
|
|
Length of hospital stay (median, d)
|
3.5
|
5.0
|
|
Length of hospital stay (mean, d)
|
3.47
|
4.96
|
|
Anastomotic leak, n (%)
|
14 (6.8%)
|
10 (4.9%)
|
Discussion
This multicenter randomized controlled trial demonstrates that standardized postoperative coffee intake significantly accelerates bowel recovery and shortens LOS after laparoscopic colorectal resection compared with fresh orange juice. These findings build on previous physiological and clinical studies and provide some of the most robust evidence to date supporting coffee as a simple adjunct within ERAS pathways (1, 2, 8–13).
Our results are broadly consistent with earlier randomized trials. Müller et al. reported earlier flatus and bowel movement in patients receiving coffee compared with warm water after colectomy (11), and Dulskas et al. described similar trends in a laparoscopic population, although their study was underpowered (12). Hasler‑Gehrer et al. found that coffee accelerated bowel function compared with tea after laparoscopic colorectal surgery, but did not demonstrate a significant reduction in LOS, likely reflecting very short baseline stays in a high‑performing ERAS program (13). By including 476 patients across three centers, our trial provides greater statistical power and more precise estimates of effect size. The use of fresh orange juice as an active comparator rather than water or tea also increases the clinical relevance of the findings, as orange juice is commonly served postoperatively for hydration and calories.
The magnitude of benefit observed in our study—approximately 25 hours earlier bowel movement and nearly two days shorter LOS—is somewhat greater than the pooled estimates reported in recent meta‑analyses (1, 2). Several factors may account for this difference. We initiated coffee systematically on POD 1, applied a fixed dosing schedule, and delivered the intervention within a homogeneous laparoscopic ERAS framework with high adherence. These features likely enhanced the expression of coffee’s biological effect on colonic motility.
The underlying mechanisms are supported by earlier physiological work. Brown et al. and Rao et al. showed that coffee triggers coordinated colonic motor responses via neurohormonal and enteric pathways, including increased gastrin and cholecystokinin release, and activation of cholinergic circuits (8, 9). That decaffeinated coffee can produce similar effects suggests a role for non‑caffeine components such as chlorogenic acids and diterpenes (10). Fresh orange juice, despite its nutritional value, does not appear to exert comparable pro‑motility effects, which is consistent with the differences observed between the two groups in our trial.
Safety is a key concern when introducing any intervention intended to stimulate bowel activity after colorectal anastomosis. In our study, overall postoperative morbidity and anastomotic leak rates were low and similar between groups, and no grade C leaks occurred. These findings mirror those of previous trials and suggest that the enhanced motility associated with coffee does not translate into increased mechanical stress on the anastomosis (11–13). The slightly higher use of laxatives observed in some prior studies was not clinically relevant and did not correspond to worse outcomes (13).
The strengths of this trial include its multicenter design, relatively large sample size, standardized ERAS‑aligned care, high adherence to the allocated drinks, and the use of both intention‑to‑treat and per‑protocol analyses. Limitations include the single‑country setting and the impossibility of blinding patients and staff to the intervention. Nevertheless, the magnitude and consistency of the effect make major bias unlikely.
From a practical standpoint, coffee is inexpensive, readily available worldwide, and well accepted by patients. Incorporating coffee into postoperative drink protocols is logistically simple and requires minimal additional resources. In resource‑limited settings, this may be a particularly attractive strategy to enhance ERAS implementation. Future research could explore the relative contributions of caffeinated versus decaffeinated coffee, optimal timing and dosing, and the impact on patient‑reported outcomes and cost‑effectiveness.
In summary, our findings support the integration of coffee as a safe, low‑cost adjunct to ERAS protocols for laparoscopic colorectal surgery to accelerate postoperative bowel recovery and reduce LOS.
Limitations
Several limitations should be acknowledged. First, although this was a multicenter trial, all participating institutions were within a single country, which may limit generalizability. Second, blinding was not feasible due to the visible nature of the intervention, introducing potential performance bias, although the effect size observed makes major bias unlikely. Third, adherence documentation relied on nursing records and may have minor variability. Fourth, while procedures were balanced between groups, the study was not powered for detailed subgroup analyses. Finally, coffee preparation (bean type or brewing method) was not strictly standardized and may influence physiological effects.
Conclusion
Standardized postoperative coffee intake, initiated on POD 1 within an ERAS framework, significantly accelerates bowel recovery and shortens hospital stay after laparoscopic colorectal resection when compared with fresh orange juice, without increasing postoperative complications or anastomotic leakage. Coffee represents a simple, safe, and inexpensive intervention that can be readily incorporated into enhanced recovery pathways for colorectal surgery.
A
Author Contribution
**Yasser Debakey:** Conceptualization, study design, supervision, data interpretation, and drafting of the manuscript.**Ahmed Refaat:** Data collection, patient management, and contribution to operative procedures.**Ahmed Kilany:** Data acquisition, postoperative follow-up, and preparation of clinical documentation.**Amr Abdallah Youssef Nofal:** Statistical analysis, preparation of tables and figures, data verification, and final manuscript editing.All authors read and approved the final manuscript.
All authors read and approved the final manuscript.
Acknowledgements
A
The authors thank the colorectal surgery teams at the National Cancer Institute, Dar Al Fouad Hospitals, and Al Salam International Hospital for their support in data collection and patient care. The authors also acknowledge the ERAS coordination teams for their role in standardized postoperative monitoring.
A
Data Availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Due to institutional regulations and patient confidentiality policies, raw patient data cannot be made publicly available.
Highlights
• Coffee significantly accelerates bowel recovery after laparoscopic colorectal surgery.
• Coffee reduces hospital stay by nearly two days compared with orange juice.
• No increase in postoperative complications or anastomotic leakage.
• Largest randomized trial evaluating postoperative coffee within ERAS pathways.
• Coffee is a simple, inexpensive, and globally accessible intervention.
References
1.Zizzo M, et al. Meta-analysis on coffee/caffeine and bowel recovery after colorectal surgery (2024).
2.Vaghiri S, et al. Updated meta-analysis of postoperative coffee and gastrointestinal recovery (2024).
3.Livingston EH, et al. Clinical burden of postoperative ileus after abdominal surgery.
4.Artinyan A, et al. Risk factors and impact of prolonged postoperative ileus.
5.Hübner M, et al. ERAS compliance and outcomes in colorectal surgery.
6.Gustafsson UO, et al. ERAS Society guidelines for colon and rectal surgery.
7.Ljungqvist O, et al. Enhanced recovery after surgery: from principles to practice.
8.Brown SR, et al. Coffee and colonic motor activity in healthy volunteers.
9.Rao SSC, et al. Effects of caffeinated and decaffeinated coffee on colon motility.
10.Watanabe J, et al. Coffee consumption and postoperative gastrointestinal function.
11.Müller SA, et al. Coffee vs warm water after colectomy: randomized trial.
12.Dulskas A, et al. Coffee and bowel function after laparoscopic colectomy.
13.Hasler–Gehrer S, et al. Coffee vs tea after laparoscopic colorectal resection: randomized trial.
14.Rahbari NN, et al. Definition and grading of anastomotic leakage.
15.Traut U, et al. Pharmacologic strategies for prevention and treatment of postoperative ileus.
A
16.Vásquez W, et al. Chewing gum to reduce POI: meta-analysis.
A
17.de Leede EM, et al. Chewing gum in colorectal surgery within ERAS: randomized trial.
A
18.Senagore AJ. Economic implications of postoperative ileus.
A
19.Grass F, et al. Minimally invasive surgery, ERAS, and recovery after colorectal resection.
A
20.Boeckxstaens GE, et al. Pathophysiology of postoperative ileus.
A
21.Kahokehr A, et al. Carbohydrate-containing drinks and postoperative recovery.
A
22.Irani JL, et al. Clinical practice guidelines for perioperative care in colon and rectal surgery.
Tables:
Table 1. Preoperative patient characteristics
|
Variable
|
Coffee (n = 238)
|
Orange (n = 238)
|
p
|
|
Age (y), mean ± SD
|
54.8 ± 20.8
|
57.6 ± 20.2
|
0.1396
|
|
Smoker
|
67 (28.2%)
|
47 (19.7%)
|
0.0317
|
|
BMI, mean ± SD
|
27.94 ± 4.00
|
28.09 ± 3.87
|
0.6881
|
|
Pulmonary disease
|
24 (10.1%)
|
19 (8.0%)
|
0.4240
|
|
Renal disease
|
13 (5.5%)
|
18 (7.6%)
|
0.3530
|
|
Diabetes mellitus
|
79 (33.2%)
|
78 (32.8%)
|
0.9223
|
|
Hypertension
|
97 (40.8%)
|
99 (41.6%)
|
0.8522
|
|
Cardiac disease
|
25 (10.5%)
|
30 (12.6%)
|
0.4734
|
|
ASA grade, mean
|
1.66
|
1.61
|
0.2526
|
Table 5. Postoperative Outcomes — Per-Protocol Analysis (Compliance ≥ 80%)
|
Outcome
|
Coffee (PP)
|
Orange (PP)
|
|
Time to first bowel movement (median, h)
|
48
|
73
|
|
Time to first bowel movement (mean, h)
|
47.2
|
72.6
|
|
Time to first flatus (median, h)
|
23
|
36
|
|
Time to first flatus (mean, h)
|
23.4
|
35.4
|
|
Bowel movements until discharge (mean)
|
5.10
|
4.14
|
|
Use of any laxative, n (%)
|
37 (17.9%)
|
49 (24.0%)
|
|
Postoperative NGT insertion, n (%)
|
9 (4.3%)
|
14 (6.9%)
|
|
Length of hospital stay (median, d)
|
3.5
|
5.0
|
|
Length of hospital stay (mean, d)
|
3.47
|
4.96
|
|
Anastomotic leak, n (%)
|
14 (6.8%)
|
10 (4.9%)
|
Table 4. Postoperative outcomes (ITT)
|
Outcome
|
Coffee (n = 238)
|
Orange (n = 238)
|
p
|
|
Time to first bowel movement (median, h)
|
47.5
|
73
|
< 0.0001
|
|
Time to first bowel movement (mean, h)
|
47.1
|
72.6
|
< 0.0001
|
|
Time to first flatus (median, h)
|
23
|
36
|
< 0.0001
|
|
Time to first flatus (mean, h)
|
23.6
|
35.6
|
< 0.0001
|
|
Bowel movements until discharge (mean)
|
5.16
|
4.17
|
—
|
|
Use of any laxative
|
40 (16.8%)
|
29 (12.2%)
|
0.0016
|
|
Postoperative NGT insertion
|
9 (3.8%)
|
14 (5.9%)
|
0.2088
|
|
Length of hospital stay (median, d)
|
3
|
5
|
< 0.0001
|
|
SSI
|
8 (3.4%)
|
15 (6.3%)
|
0.0924
|
|
Ileus
|
5 (2.1%)
|
9 (3.8%)
|
0.2779
|
|
Reoperation
|
1 (0.4%)
|
3 (1.3%)
|
0.3153
|
|
Readmission 30 days
|
3 (1.3%)
|
3 (1.3%)
|
1.0000
|
|
Anastomotic leak
|
12 (5.0%)
|
15 (6.3%)
|
0.5654
|
Table 2. Operative data
|
Variable
|
Coffee (n = 238)
|
Orange (n = 238)
|
p
|
|
Converted to open
|
38 (15.96%)
|
47 (19.75%)
|
0.2814
|
|
Duration of operation (min)
|
195.7 ± 49.2
|
195.9 ± 48.6
|
0.9731
|
|
Blood loss (mL)
|
129.1 ± 47.6
|
134.8 ± 49.1
|
0.1948
|
|
Blood transfusion (bags)
|
0.097
|
0.063
|
0.1761
|
Table 3. Postoperative compliance (POD 1–2)
|
Variable
|
Coffee (n = 238)
|
Orange (n = 238)
|
p
|
|
POD 1 Morning
|
222 (93.3%)
|
200 (84.0%)
|
0.0015
|
|
POD 1 Afternoon
|
222 (93.3%)
|
200 (84.0%)
|
0.0015
|
|
POD 1 Evening
|
223 (93.7%)
|
204 (85.7%)
|
0.0042
|
|
POD 2 Morning
|
222 (93.3%)
|
208 (87.4%)
|
0.0299
|
|
POD 2 Afternoon
|
224 (94.1%)
|
208 (87.4%)
|
0.0113
|
|
POD 2 Evening
|
228 (95.8%)
|
201 (84.5%)
|
< 0.0001
|