Time to passage of first stools
According to the literature, 19 studies reporting post-operative time to first stools were included although 13 give useable data for statistical analysis15–17,20,21,36,37,40,44–48. A total of 13 studies with 1,125 patients and 6 pharmacological treatments are reported. The extracted data are detailed in Supplemental Table 5.1. The following treatments were studied and included in the network analysis: gastrografin, dexamethasone, colloid infusion, oral carbohydrates, prokinetics and probiotics. Figure 3.A reports the network map for the 6 pharmacological treatment classes analysed. The main results are reported in Figure 3: network map, relative effect Bayesian plot, rankogram and the surface under the cumulative ranking curve (SUCRA).
Of the 6 treatments studied, prokinetics (Mean difference (MD) (hours) - 23; credible interval - 43, - 4.3 (Figure 3.B); SUCRA 0.424 (Figure 3.C)) and dexamethasone (Mean difference (MD) (hours) - 47; credible interval - 88, - 6.0 (Figure 3.B); SUCRA 0.113 (Figure 3.C)) showed a significantly faster onset of first stools compared to the control treatments. Dexamethasone was the best treatment for the duration of flatus recovery with a probability of P=0.67. The ranking (rank1+rank2+rank3) in descending order of the top three treatments from the best to the third was as follows: dexamethasone had a 90% (0.67+0.16+0.07) probability of being among the top three therapies followed by prokinetics at 50% (0.28+0.18+0.03) and then probiotics with 41% (0.05+0.17+0.18). The bias studies are summarised in Supplemental Figure 5.6. The overall bias was rated low risk in 92.3% of studies and of some concern in 7.7% of studies. The highest ratio of some concern was due to the randomisation process and deviations from intended interventions (23.1%) as well as deviation from intended intention (23.1%).