Time to first bowel movement
From the literature, 28 studies reporting post-operative first bowel
movement were included although 21 give useable data for statistical
analysis11–16,18,19,22,23,25,27–29,31,35,36,39,41,42,46.
A total of 21 studies with 3,584 patients and 7 pharmacological
treatments are reported. The extracted data are detailed in Supplemental
Table 7.1. The following treatments were studied and included in the
network analysis: prokinetics, erythromycin, opioid antagonists, NSAIDs,
probiotics, oral carbohydrates and colloid infusion. Figure 5.A reports
the network map for the 7 pharmacological treatment classes analysed.
The main results are reported in Figure 5: network map, relative effect
Bayesian plot, rankogram and the surface under the cumulative ranking
curve (SUCRA).
Of the 7 treatments studied, prokinetics (Mean difference (MD) (hours)
-25; credible interval - 39, - 11 (Figure 5.B); SUCRA 0.25 (Figure 5.C))
and opioid antagonists (Mean difference (MD) (hours) - 21; credible
interval - 39, - 3.5 (Figure 5.B); SUCRA 0.355 (Figure 5.C)) showed a
significantly faster onset of first stools compared to the control
treatments. Probiotics were the best treatment for the duration of
flatus recovery with a probability of P=0.56. The ranking
(rank1+rank2+rank3) in descending order of the top three treatments from
the best to the third was as follows: probiotics had a 75.7%
(0.56+0.11+0.07) probability of being among the top three therapies
followed by prokinetics at 75.1% (0.13+0.33+0.27) and then opioid
antagonists with 53% (0.06+0.19+0.26). The bias studies are summarised
in Supplemental Figure 7.6. The overall bias was rated low risk in
90.5% of studies and of some concern in 9.5% of studies. The highest
ratio of some concern was for deviations from intended interventions
(23.8%).