scholarly journals Systematic review of grading systems for adverse surgical outcomes

2021 ◽  
Vol 64 (2) ◽  
pp. E196-E204
Author(s):  
Saba Balvardi ◽  
Etienne St-Louis ◽  
Yasmine Yousef ◽  
Asra Toobaie ◽  
Elena Guadagno ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Outcomes ◽  
Adverse Outcomes ◽  
Postoperative Outcomes ◽  
Grading System ◽  
Study Selection ◽  
Grading Systems ◽  
Morbidity Score ◽  
Secondary Objective ◽  
Outcomes Study

Background: Grading scales for adverse surgical outcomes have been poorly characterized to date. The primary aim of this study was to conduct a systematic review to enumerate the various frameworks for grading adverse postoperative outcomes; our secondary objective was to outline the properties of each grading system, identifying its strengths and weaknesses. Methods: We searched 9 databases (Africa Wide Information, Biosis, Cochrane, Embase, Global Health, LILACs, Medline, PubMed and Web of Science) from 1992 (the year the Clavien–Dindo classification system was developed) until Mar. 2, 2017, for studies that aimed to develop or improve on an already existing generalizable system for grading adverse postoperative outcomes. Study selection was duplicated as per PRISMA recommendations. Procedure-specific grading systems were excluded. We assessed the framework, strengths and weaknesses of the systems qualitatively. Results: We identified 9 studies on 8 adverse outcome grading systems with frameworks generalizable to any surgical procedure. Most systems have not been widely incorporated in the literature. Seven of the 8 systems were produced without including patients’ perspectives. Four allowed the derivation of a composite morbidity score, which had limited tangible significance for patients. Conclusion: Although each instrument identified offered its own advantages, none satisfied the need for a patient-centred tool capable of generating a composite score of all possible postoperative adverse outcomes (complications, sequelae and failure) that enables comparison of noninterventional and surgical management of disease. There is a need for development of a more comprehensive, patient-centred grading system for adverse postoperative outcomes.

scholarly journals Frailty assessment in older urological patients prior to surgery: a systematic review and narrative synthesis

2020 ◽  
Vol 12 ◽  
pp. 175628722091661 ◽  
Author(s):  
Andrea Haren ◽  
Rajni Lal ◽  
David Walker ◽  
Rajesh Nair ◽  
Judith Partridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Care ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Adverse Outcomes ◽  
Assessment Tools ◽  
Postoperative Outcomes ◽  
Narrative Synthesis ◽  
Standard Clinical Practice ◽  
Increased Risk

Background: Radical cystectomy (RC) and urinary diversion are the recommended treatment for patients with muscle invasive bladder cancer. This is complex surgery, associated with significant patient morbidity and mortality. Frailty has been shown to be an independent risk factor for adverse outcomes in several surgical populations. Preoperative assessment of frailty is advocated in current guidelines but is not yet standard clinical practice. Aims: This systematic review and narrative synthesis aims to examine whether patients undergoing RC are assessed for frailty, what tools are used, and whether an association is found between frailty and adverse outcomes in this population. Results: Nine studies, published within the last 4 years, describe the use of tools reporting to measure frailty in the RC population. All demonstrate increased risk of adverse postoperative outcomes with higher frailty levels. Only one study used a validated frailty tool. The majority of studies measure frailty using variations on a tool derived from a large database (ACS-NSQIP) effectively counting co-morbidities, rather than assessing the multidomain nature of the frailty syndrome. Conclusion: The recognition of frailty as an important consideration in the perioperative period is welcome. This systematic review and narrative synthesis demonstrates the need for collaboration in research and delivery of clinical care for older surgical patients. Such collaboration may provide clarity regarding terms such as frailty and multimorbidity, preventing the development of assessment tools inaccurately measuring these discreet syndromes interchangeably. More accurate assessment of patients in terms of frailty, multimorbidity and functional status may allow better modification and shared decision making leading to improved postoperative outcomes in older patients undergoing RC.

Systematic review of radiological cervical foraminal grading systems

2021 ◽  
Author(s):  
James Meacock ◽  
Moritz Schramm ◽  
Senthil Selvanathan ◽  
Stuart Currie ◽  
Deborah Stocken ◽  
...  
Keyword(s):  
Systematic Review ◽  
Grading Systems

scholarly journals Epidemiology of hepatitis E virus infection in animals in Africa: a systematic review and meta-analysis

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Abdou Fatawou Modiyinji ◽  
Jean Joel Bigna ◽  
Sebastien Kenmoe ◽  
Fredy Brice N. Simo ◽  
Marie A. Amougou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hepatitis E Virus ◽  
Data Extraction ◽  
Meta Analysis ◽  
Hepatitis E ◽  
Epidemiological Studies ◽  
Cross Sectional ◽  
Resource Limited ◽  
Study Selection ◽  
Language Restriction

Abstract Background Hepatitis E virus (HEV) is a major cause of acute hepatitis in humans worldwide and have high burden in the resource-limited countries. Better knowledge of the epidemiology of hepatitis in animals in Africa can help to understand the epidemiology among humans. The objective of this study was to summarize the prevalence of HEV infection and distribution of HEV genotypes among animals in Africa. Methods In this systematic review and meta-analysis, we comprehensively searched PubMed, EMBASE, African Journals Online, and Africa Index Medicus from January 1st, 2000 to March 22th, 2020 without any language restriction. We considered cross-sectional studies of HEV infection in animals in Africa. Study selection, data extraction, and methodological quality of included studies were done independently by two investigators. Prevalence data were pooled using the random-effects meta-analysis. This review was registered in PROSPERO, CRD42018087684. Results Twenty-five studies (13 species and 6983 animals) were included. The prevalence (antibodies or ribonucleic acid [RNA]) of HEV infection in animals varied widely depending on biological markers of HEV infection measured: 23.4% (95% confidence interval; 12.0–37.2) for anti-HEV immunoglobulins G, 13.1% (3.1–28.3) for anti-HEV immunoglobulins M, and 1.8% (0.2–4.3) for RNA; with substantial heterogeneity. In subgroup analysis, the immunoglobulins G seroprevalence was higher among pigs 37.8% (13.9–65.4). The following HEV genotypes were reported in animals: Rat-HEV genotype 1 (rats and horses), HEV-3 (pigs), HEV-7 (dromedaries), and Bat hepeviruses (bats). Conclusions We found a high prevalence of HEV infection in animals in Africa and HEV genotypes close to that of humans. Some animals in Africa could be the reservoir of HEV, highlighting the need of molecular epidemiological studies for investigating zoonotic transmission.

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