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%).