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%).