Safety and effectiveness of surgical fixation versus non-surgical methods for the treatment of flail chest in adult populations: a systematic review and meta-analysis

Abstract Purpose The objective of this systematic review is to compare the safety and efficacy of surgical fixation of rib fractures against non-surgical interventions for the treatment of flail chest in the adult population. Methods A search was performed on the 22nd of July 2020 to identify articles comparing surgical fixation versus clinical management for flail chest in adults, with a description of the outcome parameters (resource utility, mortality, adverse effects of the intervention and adverse progression in pulmonary status). Relevant randomised controlled trials were selected, their risk of bias assessed, and the data then extracted and analysed. Results 157 patients were included from four studies in the analyses, with 79 and 78 patients in the surgical and non-surgical groups, respectively. The pooled effects of all outcomes tended towards favouring surgical intervention. Surgical intervention was associated with lower rates of pneumonia (I2 = 46%, Tau2 = 0.16, p = 0.16), significantly lower rates of tracheostomy (I2 = 76%, Tau2 = 0.67, p = 0.02), and a significantly lower duration of mechanical ventilation (I2 = 88%, Tau2 = 33.7, p < 0.01) in comparison to the non-surgical management methods. Conclusion Our results suggest that surgical intervention reduces the need for tracheostomy, reduces the time spent in the intensive care unit following a traumatic flail chest injury and could reduce the risk of acquiring pneumonia after such an event. There is a need for further well-designed studies with sufficient sample sizes to confirm the results of this study and also detect other possible effects of surgical intervention in the treatment of traumatic flail chest in adults.

Download Full-text

Rhinological interventions for obstructive sleep apnoea – a systematic review and descriptive meta-analysis

The Journal of Laryngology & Otology ◽

10.1017/s0022215119000240 ◽

2019 ◽

Vol 133 (03) ◽

pp. 168-176 ◽

Cited By ~ 4

Author(s):

S Sharma ◽

J C R Wormald ◽

J M Fishman ◽

P Andrews ◽

B T Kotecha

Keyword(s):

Systematic Review ◽

Obstructive Sleep Apnoea ◽

Surgical Intervention ◽

Meta Analysis ◽

Upper Airway ◽

Sleep Apnoea ◽

Current Evidence ◽

Nasal Surgery ◽

Surgical Interventions ◽

Obstructive Sleep

AbstractObjectivesObstructive sleep apnoea is a common chronic sleep disorder characterised by collapse of the upper airway during sleep. The nasal airway forms a significant part of the upper airway and any obstruction is thought to have an impact on obstructive sleep apnoea. A systematic review was performed to determine the role of rhinological surgical interventions in the management of obstructive sleep apnoea.MethodsA systematic review of current literature was undertaken; studies were included if they involved comparison of a non-surgical and/or non-rhinological surgical intervention with a rhinological surgical intervention for treatment of obstructive sleep apnoea.ResultsSixteen studies met the selection criteria. The pooled data suggest that there are reductions in the apnoea/hypopnea index and respiratory disturbance index following nasal surgery. However, the current body of studies is too heterogeneous for statistically significant meta-analysis to be conducted.ConclusionNasal surgery may have limited benefit for a subset of patients based on current evidence.

Download Full-text

Surgical or medical abortion of pregnancies between 13+0 and 23+6 weeks’ gestation? A systematic review and new NICE national guidelines

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2019-200460 ◽

2020 ◽

pp. bmjsrh-2019-200460

Author(s):

Mia Schmidt-Hansen ◽

Patricia A Lohr ◽

Sharon Cameron ◽

Elise Hasler

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Medical Abortion ◽

Cochrane Library ◽

National Guidelines ◽

Cervical Injury ◽

Surgical Methods ◽

Randomised Controlled

BackgroundAbortion in the second trimester may be performed surgically or medically. The objective of this systematic review was to examine the effectiveness, safety and acceptability/satisfaction of surgical compared with medical abortion of pregnancy between 13+0 and 23+6 weeks’ gestation for a new national guideline.MethodsWe searched Embase, Medline and the Cochrane Library on 4 March 2019. We included randomised controlled trials (RCTs; any size) and non-randomised comparative studies with n≥100 in each arm, published in English from 1985. Risk-of-bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs)used the Mantel-Haenszel method. The quality of the evidence was assessed using GRADE.ResultsTwo RCTs (n=140) were included. ‘Incomplete abortion requiring surgical intervention’ was clinically significantly higher with medical than surgical methods (RR=4.58, 95% CI 1.07 to 19.64). ‘Abortion completed by the intended method’ was statistically, but not clinically, significantly lower after medical than surgical methods, but was marked by high between-study heterogeneity (RR=0.88, 95% CI 0.79 to 0.98). To the extent that ‘haemorrhage requiring transfusion/≥500 mL blood loss’, ‘uterine injury’, ‘cervical injury requiring repair’ and ‘infection reported within 1 month of abortion’ were reported, they did not differ significantly between methods. Depending on measurement method, ‘patient satisfaction/acceptability’ was either clinically significantly higher or comparable after surgical than medical methods. The quality of this evidence was limited by low event rates and attrition bias.ConclusionBased on this evidence and consensus, women should be offered the choice of medical or surgical methods of abortion between 13+0 and 23+6 weeks’ gestation, unless not clinically appropriate.

Download Full-text

The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature

BMJ Open ◽

10.1136/bmjopen-2019-029727 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029727 ◽

Cited By ~ 10

Author(s):

Imran Ahmed ◽

Adam Jonathan Boulton ◽

Sana Rizvi ◽

William Carlos ◽

Edward Dickenson ◽

...

Keyword(s):

Systematic Review ◽

Fixed Effects ◽

Primary Outcome ◽

Meta Analysis ◽

Surgical Site Infections ◽

Causative Factor ◽

Fixed Effects Model ◽

Surgical Interventions ◽

Registration Number ◽

Randomised Controlled

Introduction and objectivesSurgical site infections (SSIs) represent a common and serious complication of all surgical interventions. Microorganisms are able to colonise sutures that are implanted in the skin, which is a causative factor of SSIs. Triclosan-coated sutures are antibacterial sutures aimed at reducing SSIs. Our objective is to update the existing literature by systematically reviewing available evidence to assess the effectiveness of triclosan-coated sutures in the prevention of SSIs.MethodsA systematic review of EMBASE, MEDLINE, AMED (Allied and complementary medicine database) and CENTRAL was performed to identify full text randomised controlled trials (RCTs) on 31 May 2019.InterventionTriclosan-coated sutures versus non-triclosan-coated sutures.Primary outcomeOur primary outcome was the development of SSIs at 30 days postoperatively. A meta-analysis was performed using a fixed-effects model.ResultsTwenty-five RCTs were included involving 11 957 participants. Triclosan-coated sutures were used in 6008 participants and non triclosan-coated sutures were used in 5949. Triclosan-coated sutures significantly reduced the risk of SSIs at 30 days (relative risk 0.73, 95% CI 0.65 to 0.82). Further sensitivity analysis demonstrated that triclosan-coated sutures significantly reduced the risk of SSIs in both clean and contaminated surgery.ConclusionTriclosan-coated sutures have been shown to significantly reduced the risk of SSIs when compared with standard sutures. This is in agreement with previous work in this area. This study represented the largest review to date in this area. This moderate quality evidence recommends the use of triclosan-coated sutures in order to reduce the risk of SSIs particularly in clean and contaminated surgical procedures.PROSPERO registration numberCRD42014014856

Download Full-text

A Systematic Review and Meta-analysis of Randomised Controlled Trials Comparing Endovenous Ablation and Surgical Intervention in Patients with Varicose Vein

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.06.060 ◽

2012 ◽

Vol 56 (2) ◽

pp. 576-577 ◽

Cited By ~ 1

Author(s):

B. Siribumrungwong ◽

P. Noorit ◽

C. Wilasrusmee ◽

J. Attia ◽

A. Thakkinstian

Keyword(s):

Systematic Review ◽

Varicose Vein ◽

Randomised Controlled Trials ◽

Surgical Intervention ◽

Meta Analysis ◽

Controlled Trials ◽

Endovenous Ablation ◽

Randomised Controlled

Download Full-text

Acupuncture for blepharospasm: a systematic review and meta-analysis protocol

10.21203/rs.3.rs-223910/v1 ◽

2021 ◽

Author(s):

Hui HUANG ◽

Qun Huang ◽

Na Gao ◽

Haoran Li ◽

Weiwen Zou ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Biomedical Literature ◽

Systematic Evaluation ◽

Controlled Trials ◽

Cochrane Central Register ◽

Eyelid Closure ◽

Surgical Interventions ◽

Oral Medications ◽

Randomised Controlled

Abstract Background Blepharospasm is a disorder inducing bilateral eyelid closure due to irregular muscle contraction. Oral medications or surgical interventions currently still hardly achieve a great therapeutic effect. Acupuncture is indicated effective in improving blepharospasm, but its efficacy has not been comprehensively elucidated as a therapy, so a systematic evaluation on acupuncture for blepharospasm is desirable. Methods All randomised controlled trials related to acupuncture for blepharospasm will be screened from 9 databases, including 5 English databases (Cochrane Central Register of Controlled Trials, Web of Science, PubMed, MEDLINE, Excerpta Medica Database) and 4 Chinese databases (CNKI, Chinese Biomedical Literature Database, China Wanfang Database, and VIP Database). The primary outcomes include degree of blepharospasm, scores of BFM, UDRS, JRC, BSS, BDS, and BSDI. The incidence of adverse events will be also considered. Two reviewers will screen studies, extract data and assess the quality. Review Manager software 5.4.1 (provided by Cochrane, London, United Kingdom) will be used to assess risk of bias and synthesize data synthesis. Discussion Our study will investigate the efficacy and safety of acupuncture in treating blepharospasm, providing a summary to contribute to application of acupuncture. Systematic review registration: CRD42020222489, registered on Dec 24, 2020.

Download Full-text