108 Chapter 4 Results Study characteristics The literature search generated 4027 references: 1671 in PubMed and 2356 in Embase. After removing duplicates, 3202 references remained. The full text of 358 articles were evaluated which resulted in the inclusion of 61 articles. An additional 10 articles were included via reference screening resulting in a total of 71 included articles (12-82). The flow chart of the search and selection process is presented in Figure 1. Characteristics of the included prospective studies are shown in Table 1. More than half (56%) of the articles were published later than 2010. Research into upper gastrointestinal surgery (68%) was most prominent. The study design of included studies was equally distributed amongst prospective case series (29%), observational cohort studies (37%) and randomized trials (34%). Studies were mostly conducted in Europe (26%), NorthAmerica (27%) and South-east Asia (28%). Reported outcome measures for postoperative ileus Specifications of the reported outcome measures are reported in Table 2. In 18 articles postoperative ileus was mentioned as an outcome, a definition was provided in eight articles (Table 3) (15, 16, 27, 28, 33, 44, 47, 51, 54, 58, 61, 66, 68, 70, 72, 73, 76, 80). One of the articles providing a definition did not report accompanying outcome measures (58). Of the eight provided definitions, four specified the timeframe of their definition. Half of the definitions were a combination of both gastric motility and intestinal motility outcomes, the other half only focused on gastric motility focussing on the ability to tolerate food. None of the definitions was based solely on intestinal motility. In 18% of the articles the outcome was stated in the method section as either primary (12%) or secondary (6%) outcome. Postoperative ileus was measured by a combination of outcome measures related to both return of gastric- and intestinal motility in 83% of which four articles were classified as both because they solely used “abdominal distension”. In 17% outcome measures only related to return of gastric motility whilst none of the studies solely used outcome measures related to intestinal motility. As displayed in Table 4, postoperative ileus was described using a total of 34 outcome measures, of which 12 were unique. Of these unique outcome measures, two out of three (67%) were reported on only once. “Abdominal distension” made up 41% of the total reported outcome measures and was classified as describing the return of both gastric- and intestinal motility. From the other outcome measures, 41% described the return of gastric motility whilst 18% described the return of intestinal motility.
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