Summary of findings 2. Subgroup and Sensitivity analyses.
| Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement | ||||||
| Patient or population: lower gastrointestinal surgery Setting: hospital Intervention: early enteral nutrition Comparison: later commencement | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk with no calories | Corresponding risk with early enteral nutrition | |||||
|
Subgroup 1: Length of hospital stay (days) distal to ligament of Treitz |
The mean LoS of control groups ranged from 6 to 17 days | MD 1.77 shorter (2.95 shorter to 0.59 shorter) |
‐ | 1156 (13 RCTs) |
⊕⊕⊝⊝ LOW1 | |
|
Subgroup 2: Length of hospital stay (days) distal and proximal to ligament of Treitz |
The mean LoS of control groups ranged from 9 to 24 days | MD 2.58 days shorter (4.40 days shorter to 0.76 days shorter) |
‐ | 190 (3 RCTs) |
⊕⊕⊝⊝ LOW2 | |
|
Subgroup 3: Length of hospital stay (days) oral feeding only |
The mean LoS of control groups ranged from 6 to 17 days. | MD 2.06 days shorter (3.26 days shorter to 0.87 days shorter) |
‐ | 1075 (11 RCTs) |
⊕⊕⊝⊝ LOW1 | |
|
Subgroup 4: Length of hospital stay (days) tube feeding with/without oral feeding |
The mean LoS of control groups ranged from 9 to 24 days. | MD 1.75 days shorter (4.32 days shorter to 0.82 days shorter) |
‐ | 271 (5 RCTs) |
⊕⊝⊝⊝ VERY LOW3 | |
|
Sensitivity analysis 2: Removing studies with imputed results |
The mean LoS of control groups ranged from seven to 17 days | MD 2.27 days shorter (3.62 days shorter to 0.92 days shorter) |
‐ | 396 (5 RCTs) |
⊕⊝⊝⊝ VERY LOW3 | |
|
Senstivity analysis 3: Worst case scenario imputation |
The mean LoS of control groups ranged from 6 to 24 days | MD 2.06 days shorter (3.18 days shorter to 0.94 days shorter) | ‐ | 235 (3 RCTs) |
⊕⊕⊝⊝ LOW1 | |
|
Senstivity analysis 4: Best case scenario imputation |
The mean LoS of control groups ranged from 6 to 24 days | MD 1.80 days shorter (2.61 days shorter to 1.00 day shorter) | ‐ | 235 (3 RCTs) |
⊕⊕⊝⊝ LOW1 | |
| *The risk in the intervention group (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). Abbrevations: CI: Confidence interval; WMD: weighted mean differences; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1Downgraded by two levels because of the following: risk of bias (blinding did not occur in any study; random sequence generation and allocation concealment were poorly reported) and inconsistency (large variation in size of effect, some confidence intervals do not overlap, very high I2)
2 Downgraded by two levels because of the following: risk of bias (blinding did not occur in any study and allocation concealment was poorly reported) and imprecision (confidence intervals are wide and only based on 3 studies)
3 Downgraded by three levels because of the following: risk of bias (blinding did not occur in any study and allocation concealment was poorly reported) and imprecision (confidence intervals are wide) and inconsistency (large variation in size of effect, some confidence intervals do not overlap, very high I2)