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%).