Time to solid food tolerance
In line with literature, 31 studies reporting post-operative time to
solid food tolerance were included although 29 give useable data for
statistical analysis13,16,18–34,36,38,40–45,47,48. A
total of 29 studies with 5,683 patients and 7 pharmacological treatments
are reported. The extracted data are detailed in Supplemental Table 6.1.
The following treatments were studied and included in the network
analysis: NSAIDs, gastrografin, opioid antagonists, colloid infusion,
erythromycin, prokinetics and probiotics. Figure 4.A reports the network
map for the 7 pharmacological treatment classes analysed. The main
results are reported in the SUCRA and rankogram in Figures 4.C and 4.D.
Of the 7 treatments studied, opioid antagonists (Mean difference (MD)
(hours) - 19; credible interval - 26, - 14 (Figure 4.B); SUCRA 0.163
(Figure 4.C)) and colloid infusion (Mean difference (MD) (hours) - 22;
credible interval - 38, - 5.5 (Figure 4.B); SUCRA 0.138 (Figure 4.C))
showed a significantly faster onset of solid food tolerance compared to
the control treatments. Colloid infusion was the best treatment for the
duration of flatus recovery with a probability of P=0.41. The ranking
(rank1+rank2+rank3) in descending order of the top three treatments from
the best to the third was as follows: opioid antagonists had a 97%
(0.20+0.46+0.31) probability of being among the top three therapies
followed by colloid infusion at 92% (0.41+0.31+0.2) and then
gastrografin with 75% (0.36+0.17+0.22). The bias studies are summarised
in Supplemental Figure 6.6. The overall bias was rated low risk in 100%
of studies and of some concern in 0% of studies. The highest ratio of
some concern was for deviations from intended interventions (13.8%).