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Frühe versus späte orale Flüssigkeits‐ und Nahrungsaufnahme zur Reduktion von Komplikationen nach großen abdominalen gynäkologischen Operationen

Appendices

Appendix 1. MDSG search strategy

MDSG Search strategy for KC813 15.06.11

Keywords CONTAINS "gynecologic surgical procedure"or "salpingectomy"or"salpingo‐oopherectomy" or "*Salpingostomy‐" or "salpingotomy" or "surgery" or "surgery‐gynaecological" or"Surgical"or "myomectomy"or "Hysterectomy,abdominal"or "total abdominal hysterectomy" or "abdominal myomectomy"or"abdominal hysterectomy"or"abdominal myomectomy" or Title CONTAINS "gynecologic surgical procedure"or "salpingectomy"or"salpingo‐oopherectomy" or "*Salpingostomy‐" or "salpingotomy" or "surgery" or "surgery‐gynaecological" or"Surgical"or "myomectomy"or "Hysterectomy,abdominal"or "total abdominal hysterectomy" or "abdominal myomectomy"or"abdominal hysterectomy"or"abdominal myomectomy"

AND

Keywords CONTAINS "Food intake"or "early feeding"or"starved state" or Title CONTAINS "Food intake"or "early feeding"or"starved state" or"starved state"

Appendix 2. CENTRAL search strategy

1 (surgery or surgical).tw. (67324)
2 exp General Surgery/ (227)
3 exp Postoperative Complications/ (24734)
4 postoperative.tw. (35065)
5 exp Gynecologic Surgical Procedures/ (3154)
6 or/1‐5 (86713)
7 (gynecol$ or gynaecol$).tw. (4596)
8 exp Gynecology/ (87)
9 (abdomin$ or abdomen$).tw. (11988)
10 exp Abdomen/ (2194)
11 exp Pelvis/ (538)
12 pelvi$.tw. (4062)
13 intraabdominal.tw. (308)
14 hysterectom$.tw. (2321)
15 or/7‐14 (21207)
16 exp eating/ or exp gastrointestinal motility/ (4623)
17 exp Food/ (29667)
18 exp Feeding Methods/ or exp Feeding Behavior/ (7376)
19 feeding.tw. (5096)
20 food.tw. (9126)
21 fluid$.tw. (10387)
22 oral.tw. (55828)
23 water.tw. (10191)
24 solid$.tw. (3058)
25 eating.tw. (3105)
26 eat.tw. (725)
27 or/16‐26 (111186)
28 early.tw. (41225)
29 exp Time Factors/ (45655)
30 (time or timing).tw. (113194)
31 day one.tw. (762)
32 day two.tw. (740)
33 or/28‐32 (173700)
34 6 and 15 and 27 and 33 (606)
35 limit 34 to yr="2012 ‐Current" (51)

Appendix 3. MEDLINE search strategy

1 (surgery or surgical).tw. (1204744)
2 exp General Surgery/ (33397)
3 exp Postoperative Complications/ (411947)
4 postoperative.tw. (303965)
5 exp Gynecologic Surgical Procedures/ (63349)
6 or/1‐5 (1586874)
7 (gynecol$ or gynaecol$).tw. (71639)
8 exp Gynecology/ (13214)
9 (abdomin$ or abdomen$).tw. (244185)
10 exp Abdomen/ (80147)
11 exp Pelvis/ (18399)
12 pelvi$.tw. (98306)
13 intraabdominal.tw. (6783)
14 hysterectom$.tw. (26049)
15 or/7‐14 (460798)
16 exp eating/ or exp gastrointestinal motility/ (88490)
17 exp Food/ (1038694)
18 exp Feeding Methods/ or exp Feeding Behavior/ (152611)
19 feeding.tw. (134574)
20 food.tw. (248095)
21 fluid$.tw. (348392)
22 oral.tw. (419172)
23 water.tw. (491988)
24 solid$.tw. (218823)
25 eating.tw. (44448)
26 eat.tw. (12050)
27 or/16‐26 (2648763)
28 early.tw. (1029482)
29 exp Time Factors/ (989633)
30 (time or timing).tw. (2037094)
31 day one.tw. (2125)
32 day two.tw. (1070)
33 or/28‐32 (3546350)
34 6 and 15 and 27 and 33 (4855)
35 randomized controlled trial.pt. (368553)
36 controlled clinical trial.pt. (87954)
37 randomized.ab. (288824)
38 randomised.ab. (57687)
39 placebo.tw. (156289)
40 clinical trials as topic.sh. (168882)
41 randomly.ab. (209520)
42 trial.ti. (123979)
43 (crossover or cross‐over or cross over).tw. (59999)
44 or/35‐43 (931125)
45 exp animals/ not humans.sh. (3907798)
46 44 not 45 (858747)
47 34 and 46 (768)
48 (2012$ or 2013$ or 2014$).ed. (2212373)
49 (2012$ or 2013$ or 2014$).dp. (2164044)
50 48 or 49 (2713731)
51 47 and 50 (132)

Appendix 4. EMBASE search strategy

1 gynecologic surgery/ or uterine tube surgery/ or salpingoplasty/ or salpingostomy/ or uterus surgery/ or hysterectomy/ or abdominal hysterectomy/ or hysterotomy/ or radical hysterectomy/ (53972)
2 ovariectomy/ or salpingooophorectomy/ (32953)
3 ((gynecolog$ or gynaecolog$) adj5 surg$).tw. (11122)
4 ((gynecolog$ or gynaecolog$) adj5 operat$).tw. (2627)
5 (hysterectomy or ovariectomy or salpingostomy or salpingooophorectomy).tw. (41333)
6 exp Uterus Tumor/su [Surgery] (25970)
7 exp Ovary Tumor/su [Surgery] (14387)
8 or/1‐7 (116284)
9 food intake/ or drinking/ or eating/ (108665)
10 feeding/ (26586)
11 feeding behavior/ (52426)
12 (oral adj5 intak$).tw. (8436)
13 (intake adj5 (food or drink or fluid$)).tw. (50060)
14 (postoperat$ adj5 feed$).tw. (1071)
15 (tradition$ adj5 feed$).tw. (460)
16 (tradition$ adj5 intake$).tw. (306)
17 (early adj5 feed$).tw. (4248)
18 (early adj5 intake$).tw. (1386)
19 (delay$ adj5 feed$).tw. (2130)
20 (delay$ adj5 intake$).tw. (503)
21 (timing adj4 intake).tw. (242)
22 (timing adj4 feed$).tw. (403)
23 fasting.tw. (94474)
24 nil per mouth.tw. (7)
25 nil per os.tw. (100)
26 or/9‐25 (294313)
27 8 and 26 (1103)
28 Clinical Trial/ (829495)
29 Randomized Controlled Trial/ (338330)
30 exp randomization/ (61474)
31 Single Blind Procedure/ (18001)
32 Double Blind Procedure/ (112268)
33 Crossover Procedure/ (38288)
34 Placebo/ (236087)
35 Randomi?ed controlled trial$.tw. (95686)
36 Rct.tw. (13359)
37 random allocation.tw. (1288)
38 randomly allocated.tw. (19758)
39 allocated randomly.tw. (1894)
40 (allocated adj2 random).tw. (707)
41 Single blind$.tw. (13923)
42 Double blind$.tw. (137961)
43 ((treble or triple) adj blind$).tw. (351)
44 placebo$.tw. (193373)
45 prospective study/ (244428)
46 or/28‐45 (1338033)
47 case study/ (25023)
48 case report.tw. (253523)
49 abstract report/ or letter/ (882948)
50 or/47‐49 (1156030)
51 46 not 50 (1300837)
52 27 and 51 (137)
53 (2012$ or 2013$ or 2014$).em. (3244058)
54 52 and 53 (27)

Appendix 5. CINAHL search strategy

KC813 CINAHL search strategy 01.04.14

#

Query

Results

S34

S18 AND S32

8

S33

S18 AND S32

72

S32

S19 OR S20 or S21 or S22 OR S23 OR S24 OR S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31

880,148

S31

TX allocat* random*

3,851

S30

(MH "Quantitative Studies")

11,743

S29

(MH "Placebos")

8,683

S28

TX placebo*

31,261

S27

TX random* allocat*

3,851

S26

(MH "Random Assignment")

36,901

S25

TX randomi* control* trial*

70,671

S24

TX ( (singl* n1 blind*) or (singl* n1 mask*) ) or TX ( (doubl* n1 blind*) or (doubl* n1 mask*) ) or TX ( (tripl* n1 blind*) or (tripl* n1 mask*) ) or TX ( (trebl* n1 blind*) or (trebl* n1 mask*) )

707,698

S23

TX ( (trebl* n1 blind*) or (trebl* n1 mask*) )

103

S22

TX ( (trebl* n1 blind*) or (trebl* n1 mask*) )

0

S21

TX clinic* n1 trial*

161,901

S20

PT Clinical trial

75,662

S19

(MH "Clinical Trials+")

172,920

S18

S7 AND S17

288

S17

S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16

200,933

S16

TX eat*

32,854

S15

(MH "Food Intake+")

5,373

S14

TX drink*

28,560

S13

TX feed*

47,112

S12

TX "food"

98,420

S11

TX "oral intake"

645

S10

TX "fasting"

10,669

S9

TX "nil by mouth"

62

S8

TX fluids

5,646

S7

S1 OR S2 OR S3 OR S4 OR S5 OR S6

9,613

S6

TX Hysterectomy

4,816

S5

TX Oophorectomy

1,898

S4

TX gyn?ecolog* surg*

432

S3

(MM "Oophorectomy")

590

S2

(MH "Hysterectomy+")

3,860

S1

(MH "Surgery, Gynecologic+")

8,310

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 1 Postoperative ileus.
Figuras y tablas -
Analysis 1.1

Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 1 Postoperative ileus.

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Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 2 Time intervals (fixed‐effect model) [days].
Figuras y tablas -
Analysis 1.2

Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 2 Time intervals (fixed‐effect model) [days].

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Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 3 Other major postoperative complications.
Figuras y tablas -
Analysis 1.3

Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 3 Other major postoperative complications.

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Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 4 Satisfaction visual analog scale [mm].
Figuras y tablas -
Analysis 1.4

Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 4 Satisfaction visual analog scale [mm].

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Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 5 Nausea and/or vomiting (random‐effects model).
Figuras y tablas -
Analysis 1.5

Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 5 Nausea and/or vomiting (random‐effects model).

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Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 6 Time to the presence of bowel sound (random‐effects model) [days].
Figuras y tablas -
Analysis 1.6

Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 6 Time to the presence of bowel sound (random‐effects model) [days].

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Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 7 Time to the first solid diet (random‐effects model) [days].
Figuras y tablas -
Analysis 1.7

Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 7 Time to the first solid diet (random‐effects model) [days].

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Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 8 Hospital stay (random‐effects model) [days].
Figuras y tablas -
Analysis 1.8

Comparison 1 Early versus delayed oral fluids and food after major abdominal gynaecologic surgery, Outcome 8 Hospital stay (random‐effects model) [days].

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Summary of findings for the main comparison. Early oral feeding compared to delayed oral feeding for women who had major abdominal gynaecologic surgery

Early oral feeding compared to delayed oral feeding for women who had major abdominal gynaecologic surgery

Patient or population: Women who had major abdominal gynaecologic surgery
Settings: University hospital/cancer centre
Intervention: Early oral feeding
Comparison: Delayed (traditional) oral feeding

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Delayed oral feeding

Early oral feeding

Postoperative ileus

77 per 1000

36 per 1000
(13 to 99)

RR 0.47
(0.17 to 1.29)

279
(3 studies)

⊕⊕⊕⊝
moderate1

Nausea or vomiting or both

352 per 1000

363 per 1000
(225 to 588)

RR 1.03
(0.64 to 1.67)

484
(4 studies)

⊕⊕⊕⊝
moderate2

Random effects model, deployed because of substantial heterogeneity between studies (I2> 50%)

Time to bowel sounds [days]

The mean time to the presence of bowel sound [days] in the intervention groups was
0.32 lower
(0.61 to 0.03 lower)

338
(2 studies)

⊕⊕⊕⊝
moderate3

Random effects model, deployed because of substantial heterogeneity between studies (I2> 50%)

Time to the passage of flatus [days]

The mean time to the passage of flatus [days] in the intervention groups was
0.21 lower
(0.4 to 0.01 lower)

444
(3 studies)

⊕⊕⊕⊕
high

Time to the first solid diet [days]

The mean time to the first solid diet [days] in the intervention groups was
1.47 lower
(2.26 to 0.68 lower)

301
(2 studies)

⊕⊕⊕⊝
moderate3

Random effects model, deployed because of substantial heterogeneity between studies (I2> 50%)

Time to first passage of stool [days]

The mean time to first passage of stool [days] in the intervention groups was
0.25 lower
(0.58 lower to 0.09 higher)

249
(2 studies)

⊕⊕⊕⊝
moderate3

Hospital stay [days]

The mean hospital stay [days] in the intervention groups was
0.92 lower
(1.53 to 0.31 lower)

484
(4 studies)

⊕⊕⊕⊝
moderate4

Random effects model, deployed because of substantial heterogeneity between studies (I2> 50%)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 For the three studies contributing data, all were at high risk of performance bias, two were at unclear risk of detection bias, and one was at high risk of selection bias (no allocation concealment).
2 For the four studies contributing data, all were at high risk of performance bias and unclear risk of detection bias.
3 This outcome may be influenced by the high risk of performance bias in the two studies that contributed data.

4 This outcome may be influenced by the high risk of performance bias in all studies that provided data.

Figuras y tablas -
Summary of findings for the main comparison. Early oral feeding compared to delayed oral feeding for women who had major abdominal gynaecologic surgery
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Comparison 1. Early versus delayed oral fluids and food after major abdominal gynaecologic surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Postoperative ileus Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Postoperative ileus

3

279

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.17, 1.29]

1.2 Nausea and/or vomiting (fixed‐effect model)

4

484

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.88, 1.38]

1.3 Nausea

1

195

Risk Ratio (M‐H, Fixed, 95% CI)

1.79 [1.19, 2.71]

1.4 Vomiting

2

301

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.37, 2.00]

1.5 Abdominal distension

2

301

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.77, 1.47]

1.6 Postoperative placement of nasogastric tube

1

195

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.13, 1.80]

2 Time intervals (fixed‐effect model) [days] Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Time to the presence of bowel sound (fixed‐effect model) [days]

2

338

Mean Difference (IV, Fixed, 95% CI)

‐0.29 [‐0.48, ‐0.11]

2.2 Time to the passage of flatus [days]

3

444

Mean Difference (IV, Fixed, 95% CI)

‐0.21 [‐0.40, ‐0.01]

2.3 Time to the first solid diet (fixed‐effect model) [days]

2

301

Mean Difference (IV, Fixed, 95% CI)

‐1.19 [‐1.34, ‐1.05]

2.4 Time to the first passage of stool [days]

2

249

Mean Difference (IV, Fixed, 95% CI)

‐0.25 [‐0.58, 0.09]

2.5 Hospital stay (fixed‐effect model) [days]

4

484

Mean Difference (IV, Fixed, 95% CI)

‐0.59 [‐0.83, ‐0.35]

3 Other major postoperative complications Show forest plot

4

1286

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.63, 1.01]

3.1 Febrile morbidity

1

195

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.76, 1.27]

3.2 Infectious complications

2

183

Risk Ratio (M‐H, Fixed, 95% CI)

0.20 [0.05, 0.73]

3.3 Wound complications

4

474

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.50, 1.35]

3.4 Pneumonia

3

434

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.07, 1.73]

4 Satisfaction visual analog scale [mm] Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5 Nausea and/or vomiting (random‐effects model) Show forest plot

4

484

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.64, 1.67]

6 Time to the presence of bowel sound (random‐effects model) [days] Show forest plot

2

338

Mean Difference (IV, Random, 95% CI)

‐0.32 [‐0.61, ‐0.03]

7 Time to the first solid diet (random‐effects model) [days] Show forest plot

2

301

Mean Difference (IV, Random, 95% CI)

‐1.47 [‐2.26, ‐0.68]

8 Hospital stay (random‐effects model) [days] Show forest plot

4

484

Mean Difference (IV, Random, 95% CI)

‐0.92 [‐1.53, ‐0.31]
Figuras y tablas -
Comparison 1. Early versus delayed oral fluids and food after major abdominal gynaecologic surgery
Ir a la tabla de la revisión