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Cochrane Database of Systematic Reviews

Administración de líquidos y alimentos por vía oral temprana versus tardía para la disminución de las complicaciones después de la cirugía ginecológica abdominal mayor

Información

DOI:
https://doi.org/10.1002/14651858.CD004508.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 12 diciembre 2014see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Ginecología y fertilidad

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Kittipat Charoenkwan

    Correspondencia a: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    [email protected]

  • Elizabeth Matovinovic

    Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

Contributions of authors

Kittipat Charoenkwan: Took the lead in writing the protocol. For the review took the lead in writing, selected trials for inclusion, performed independent data extraction, statistical analysis and interpretation of data.

Elizabeth Matovinovic: For the updated review, selected articles for inclusion, performed independent data extraction, assessed risk of bias for included articles, data interpretation, and contributed to writing.

Sources of support

Internal sources

  • Faculty of Medicine, Chiang Mai University, Thailand.

    Funding

External sources

  • National Research University Project under Thailand’s Office of the Higher Education Commission, Thailand.

    Funding

Declarations of interest

Kittipat Charoenkwan: None
Elizabeth Matovinovic: None

Acknowledgements

We wish to thanks the Cochrane Menstrual Disorders and Subfertility Group (CMDSG) editorial group for their support. We would like to acknowledge the contribution of Greg Phillipson and Teraporn Vutyavanich for their contribution to the original version of this review.

Version history

Published

Title

Stage

Authors

Version

2014 Dec 12

Early versus delayed oral fluids and food for reducing complications after major abdominal gynaecologic surgery

Review

Kittipat Charoenkwan, Elizabeth Matovinovic

https://doi.org/10.1002/14651858.CD004508.pub4

2007 Oct 17

Early versus delayed oral fluids and food for reducing complications after major abdominal gynaecologic surgery

Review

Kittipat Charoenkwan, Greg Phillipson, Teraporn Vutyavanich

https://doi.org/10.1002/14651858.CD004508.pub3

2006 Jul 19

Early versus delayed (traditional) oral fluids and food for reducing complications after major abdominal gynaecologic surgery

Protocol

Kittipat Charoenkwan, Greg Phillipson, Theera Tongsong

https://doi.org/10.1002/14651858.CD004508.pub2

2003 Oct 20

Early versus delayed (traditional) oral fluids and food for reducing complications after major abdominal gynaecologic surgery

Protocol

Kittipat Charoenkwan, Greg Phillipson, Theera Tongsong

https://doi.org/10.1002/14651858.CD004508

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Female; Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

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.
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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].
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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.
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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].
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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).
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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].
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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].
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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].
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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
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