Time to passage of first flatus
From the literature, 33 studies reporting the time to first flatus were
included although 27 give useable data for statistical analysis11,13–25,27–29,32,36–41,44,45,48. A total of 27
studies with 4,351 patients and 9 pharmacological treatments are
reported. The extracted data are detailed in Supplemental Table 4.1. The
following treatments were studied and included in the network analysis:
opioid antagonists, NSAIDs, gastrografin, erythromycin, dexamethasone,
colloid infusion, oral carbohydrates, prokinetics and probiotics. Figure
2.A reports the network map for the 9 pharmacological treatment classes
analysed. The main results are reported in Figure 2: network map,
relative effect Bayesian plot, rankogram and the surface under the
cumulative ranking curve (SUCRA).
Of the 9 treatments studied, prokinetics showed a significantly faster
onset of first flatus compared to the control treatments (Mean
difference (MD) (hours) – 16; credible interval - 30, - 3.1 (Figure
2.B); SUCRA 0.418 (Figure 2.C)). Dexamethasone was the best treatment
for the duration of flatus recovery with a probability of P=0.33. 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 62% (0.33+0.17+0.10) probability of being among the top three
therapies followed by colloid infusion at 59% (0.28+0.19+0.12) and then
prokinetics with 23% (0.01+0.07+0.15). Considering the relative effect,
there was no significant difference between dexamethasone and colloid
infusion and between dexamethasone and prokinetics. The bias studies are
summarised in Supplemental Figure 4.6. The overall bias was rated low
risk in 96.3% of studies and of some concern in 3.7% of studies. The
highest ratio of some concern was for deviation from intended
intervention (18.5%) and measurement outcomes (18.5%).