Effects of Perioperative Dexmedetomidine on Postoperative Mortality and Morbidity: A Systematic Review and Meta-analysis

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

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Influenza-associated disease burden in mainland China: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-82161-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jing Li ◽

Yinzi Chen ◽

Xiling Wang ◽

Hongjie Yu

Keyword(s):

Systematic Review ◽

Publication Bias ◽

Fixed Effects ◽

Disease Burden ◽

Outpatient Visit ◽

Meta Analysis ◽

Age Groups ◽

Mainland China ◽

Mortality And Morbidity ◽

All Cause Mortality

AbstractInfluenza causes substantial morbidity and mortality. Many original studies have been carried out to estimate disease burden of influenza in mainland China, while the full disease burden has not yet been systematically reviewed. We did a systematic review and meta-analysis to assess the burden of influenza-associated mortality, hospitalization, and outpatient visit in mainland China. We searched 3 English and 4 Chinese databases with studies published from 2005 to 2019. Studies reporting population-based rates of mortality, hospitalization, or outpatient visit attributed to seasonal influenza were included in the analysis. Fixed-effects or random-effects model was used to calculate pooled estimates of influenza-associated mortality depending on the degree of heterogeneity. Meta-regression was applied to explore the sources of heterogeneity. Publication bias was assessed by funnel plots and Egger’s test. We identified 30 studies eligible for inclusion with 17, 8, 5 studies reporting mortality, hospitalization, and outpatient visit associated with influenza, respectively. The pooled influenza-associated all-cause mortality rates were 14.33 and 122.79 per 100,000 persons for all ages and ≥ 65 years age groups, respectively. Studies were highly heterogeneous in aspects of age group, cause of death, statistical model, geographic location, and study period, and these factors could explain 60.14% of the heterogeneity in influenza-associated mortality. No significant publication bias existed in estimates of influenza-associated all-cause mortality. Children aged < 5 years were observed with the highest rates of influenza-associated hospitalizations and ILI outpatient visits. People aged ≥ 65 years and < 5 years contribute mostly to mortality and morbidity burden due to influenza, which calls for targeted vaccination policy for older adults and younger children in mainland China.

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Real-world adherence to oral anticoagulants in atrial fibrillation patients: a study protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-025102 ◽

2018 ◽

Vol 8 (12) ◽

pp. e025102 ◽

Cited By ~ 3

Author(s):

Clara L Rodríguez-Bernal ◽

Aníbal García-Sempere ◽

Isabel Hurtado ◽

Yared Santa-Ana ◽

Salvador Peiró ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Real World ◽

Observational Studies ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Medication Possession Ratio ◽

Essential Element ◽

Study Endpoint ◽

Mortality And Morbidity

IntroductionAtrial fibrillation (AF) is one of the leading causes of cerebrovascular mortality and morbidity. Oral anticoagulants (OACs) have been shown to reduce the incidence of cardioembolic stroke in patients with AF, adherence to treatment being an essential element for their effectiveness. Since the release of the first non-vitamin K antagonist oral anticoagulant, several observational studies have been carried out to estimate OAC adherence in the real world using pharmacy claim databases or AF registers. This systematic review aims to describe secondary adherence to OACs, to compare adherence between OACs and to analyse potential biases in OAC secondary adherence studies using databases.Methods and analysisWe searched on PubMed, SCOPUS and Web of Science databases (completed in 26 September 2018) to identify longitudinal observational studies reporting days’ supply adherence measures with OAC in patients with AF from refill databases or AF registers. The main study endpoint will be the percentage of patients exceeding the 80% threshold in proportion of days covered or the medication possession ratio. Two reviewers will independently screen potential studies and will extract data in a structured format. A random-effects meta-analysis will be carried out to pool study estimates. The risk of bias will be assessed using the Newcastle-Ottawa Scale for observational studies and we will also assess some study characteristics that could affect days’ supply adherence estimates.Ethics and disseminationThis systematic review using published aggregated data does not require ethics approval according to Spanish law and international regulations. The final results will be published in a peer-review journal and different social stakeholders, non-academic audiences and patients will be incorporated into the diffusion activities.PROSPERO registration numberCRD42018095646.

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Impact of Lymphadenectomy on the Oncologic Outcome of Patients with Adrenocortical Carcinoma—A Systematic Review and Meta-Analysis

Cancers ◽

10.3390/cancers14020291 ◽

2022 ◽

Vol 14 (2) ◽

pp. 291

Author(s):

Anne Hendricks ◽

Sophie Müller ◽

Martin Fassnacht ◽

Christoph-Thomas Germer ◽

Verena A. Wiegering ◽

...

Keyword(s):

Systematic Review ◽

Adrenocortical Carcinoma ◽

Survival Benefit ◽

Meta Analysis ◽

Postoperative Mortality ◽

Length Of Hospital Stay ◽

Oncologic Outcome ◽

Stage I ◽

Tumor Stages ◽

The Impact

(1) Background: Locoregional lymphadenectomy (LND) in adrenocortical carcinoma (ACC) may impact oncological outcome, but the findings from individual studies are conflicting. The aim of this systematic review and meta-analysis was to determine the oncological value of LND in ACC by summarizing the available literature. (2) Methods: A systematic search on studies published until December 2020 was performed according to the PRISMA statement. The primary outcome was the impact of lymphadenectomy on overall survival (OS). Two separate meta-analyses were performed for studies including patients with localized ACC (stage I–III) and those including all tumor stages (I–IV). Secondary endpoints included postoperative mortality and length of hospital stay (LOS). (3) Results: 11 publications were identified for inclusion. All studies were retrospective studies, published between 2001–2020, and 5 were included in the meta-analysis. Three studies (N = 807 patients) reported the impact of LND on disease-specific survival in patients with stage I–III ACC and revealed a survival benefit of LND (hazard ratio (HR) = 0.42, 95% confidence interval (95% CI): 0.26–0.68). Based on results of studies including patients with ACC stage I–IV (2 studies, N = 3934 patients), LND was not associated with a survival benefit (HR = 1.00, 95% CI: 0.70–1.42). None of the included studies showed an association between LND and postoperative mortality or LOS. (4) Conclusion: Locoregional lymphadenectomy seems to offer an oncologic benefit in patients undergoing curative-intended surgery for localized ACC (stage I–III).

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Patient Characteristics and Outcomes in Unintentional, Non-fatal Prescription Opioid Overdoses: A Systematic Review

January 2018 - Pain Physician ◽

10.36076/ppj/2019.19.215 ◽

2016 ◽

Vol 4;19 (4;5) ◽

pp. 215-228 ◽

Cited By ~ 2

Author(s):

Mark J. Elzey

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Opioid Analgesics ◽

Risk Indicators ◽

Phase Iii ◽

Health Concern ◽

Prescription Opioid ◽

Opioid Overdose ◽

Mortality And Morbidity ◽

Societal Burden

Background: Opioid overdose continues to be a significant and growing cause of preventable mortality and morbidity. Studies suggest that unintentional, non-fatal overdose from prescription opioid analgesics constitutes a large portion of total overdose events. The societal burden associated with these events is a frequently overlooked public health concern. Objectives: To evaluate unintentional, non-fatal prescription opioid overdoses, including the identification of risk factors, societal burden, and knowledge gaps where further study is warranted. Study Design: Systematic review of the literature for unintentional, non-fatal opioid overdose. Methods: Preferred reporting items for systematic reviews and meta-analyses guidelines were used in constructing this systematic review. To determine the scope of the existing literature, a systematic search was conducted using the MEDLINE, CINAHL, PsycINFO, and Web of Science databases. Results: This systematic review analyzes 24 articles (21 retrospective descriptive analyses, 2 prospective analyses, one phase III trial, and one meta-analysis). Articles were reviewed by authors and relevant data examined. Results show that opioid overdose morbidity is significantly more prevalent than mortality and sequelae of non-fatal events should be studied in more detail. Limitations: The limitations of this systematic review include the range of study populations and opioids discussed and the broad and variable definitions of “opioid overdose” in the literature. Conclusion(s): Opioid overdose morbidity and mortality is seen across the entire spectrum of inpatient and outpatient use with significant numbers of adverse events occurring in population segments not identified by high risk indicators. Increased physician awareness and a multi-modal approach could help mitigate the overdose epidemic while maintaining effective pain control for patients. Key words: Prescription, opioid, accidental drug overdose, unintentional overdose, drug poisoning, fentanyl, oxycodone, hydrocodone, methadone, oxymorphone, hydromorphone

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Probiotics Reduce Mortality and Morbidity in Preterm, Low-Birth-Weight Infants: A Systematic Review and Network Meta-analysis of Randomized Trials

Gastroenterology ◽

10.1053/j.gastro.2020.05.096 ◽

2020 ◽

Vol 159 (2) ◽

pp. 467-480 ◽

Cited By ~ 7

Author(s):

Rebecca L. Morgan ◽

Geoffrey A. Preidis ◽

Purna C. Kashyap ◽

Adam V. Weizman ◽

Behnam Sadeghirad ◽

...

Keyword(s):

Systematic Review ◽

Birth Weight ◽

Low Birth Weight ◽

Randomized Trials ◽

Meta Analysis ◽

Low Birth Weight Infants ◽

Mortality And Morbidity

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Drug Use and Postoperative Mortality Following Valve Surgery for Infective Endocarditis: A Systematic Review and Meta-analysis

Clinical Infectious Diseases ◽

10.1093/cid/ciy1064 ◽

2018 ◽

Vol 69 (7) ◽

pp. 1120-1129 ◽

Cited By ~ 15

Author(s):

Ryan Hall ◽

Michael Shaughnessy ◽

Griffin Boll ◽

Kenneth Warner ◽

Helen W Boucher ◽

...

Keyword(s):

Systematic Review ◽

Infective Endocarditis ◽

Drug Use ◽

Injection Drug Use ◽

Systematic Reviews ◽

Meta Analysis ◽

Postoperative Mortality ◽

Valve Surgery ◽

Injection Drug ◽

Significant Difference

AbstractBackgroundInfective endocarditis (IE) often requires surgical intervention. An increasingly common cause of IE is injection drug use (IDU-IE). There is conflicting evidence on whether postoperative mortality differs between people with IDU-IE and people with IE from etiologies other than injection drug use (non–IDU-IE). In this manuscript, we compare short-term postoperative mortality in IDU-IE vs non–IDU-IE through systematic review and meta-analysis.MethodsThe review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Publication databases were queried for key terms included in articles up to September 2017. Randomized controlled trials, prospective cohorts, or retrospective cohorts that reported on 30-day mortality or in-hospital/operative mortality following valve surgery and that compared outcomes between IDU-IE and non–IDU-IE were included.ResultsThirteen studies with 1593 patients (n = 341 [21.4%] IDU-IE) were included in the meta-analysis. IDU-IE patients more frequently had tricuspid valve infection, Staphylococcus infection, and heart failure before surgery. Meta-analysis revealed no statistically significant difference in 30-day postsurgical mortality or in-hospital mortality between the 2 groups.ConclusionsDespite differing preoperative clinical characteristics, early postoperative mortality does not differ between IDU-IE and non–IDU-IE patients who undergo valve surgery. Future research on long-term outcomes following valve replacement is needed to identify opportunities for improved healthcare delivery with IDU-IE.

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PCV100 THE RELATIONSHIP BETWEEN PROCEDURAL VOLUME AND POSTOPERATIVE MORTALITY FOR PERCUTANEOUS CORONARY INTERVENTIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Value in Health ◽

10.1016/j.jval.2019.09.824 ◽

2019 ◽

Vol 22 ◽

pp. S560

Author(s):

K. Walsh ◽

K.K. O'Brien ◽

T. Plunkett ◽

P. Harrington ◽

C. Teljeur ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Postoperative Mortality ◽

Percutaneous Coronary Interventions ◽

Coronary Interventions ◽

Procedural Volume ◽

Percutaneous Coronary ◽

The Relationship

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Nanoparticle-Based Chemotherapy Formulations for Head and Neck Cancer: A Systematic Review and Perspectives

Nanomaterials ◽

10.3390/nano10101938 ◽

2020 ◽

Vol 10 (10) ◽

pp. 1938

Author(s):

Jefferson Muniz de Lima ◽

Paulo Rogerio Bonan ◽

Danyel Elias da Cruz Perez ◽

Michael Hier ◽

Moulay A. Alaoui-Jamali ◽

...

Keyword(s):

Systematic Review ◽

Head And Neck Cancer ◽

Side Effects ◽

Head And Neck ◽

Neck Cancer ◽

Meta Analysis ◽

Basic Research ◽

Cochrane Central Register ◽

Level Of Evidence ◽

Mortality And Morbidity

Head and neck cancer (HNC) is a complex and heterogeneous disease associated with high mortality and morbidity worldwide. Standard therapeutic management of advanced HNC, which is based on radiotherapy often combined with chemotherapy, has been hampered by severe long-term side effects. To overcome these side effects, tumor-selective nanoparticles have been exploited as a potential drug delivery system to improve HNC therapy. A combination of MEDLINE, EMBASE, Cochrane Oral Health Group’s Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov from inception up to June 2020 was used for this systematic review. A total of 1747 published manuscripts were reviewed and nine relevant references were retrieved for analysis, while eight of them were eligible for meta-analysis. Based on these studies, the level of evidence about the efficacy of nanoformulation for HNC therapy on tumor response and adverse side effects (SAE) was low. Even though basic research studies have revealed a greater promise of nanomaterial to improve the outcome of cancer therapy, none of them were translated into clinical benefits for HNC patients. This systematic review summarized and discussed the recent progress in the development of targeted nanoparticle approaches for HNC management, and open-up new avenues for future perspectives.

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