A Cochrane systematic review and network meta-analysis comparing treatment strategies aiming to decrease blood loss during liver resection

Background: Theoretical advantages of robotic surgery compared to conventional laparoscopic surgery include improved instrument dexterity, 3D visualization, and better ergonomics. This systematic review and meta-analysis aimed to determine advantages of robotic surgery over laparoscopic surgery in patients undergoing liver resections. Method: A systematic literature search was conducted for studies comparing robotic assisted or totally laparoscopic liver resection. Meta-analysis of intraoperative (operative time, blood loss, transfusion rate, conversion rate), oncological (R0 resection rates), and postoperative (bile leak, surgical site infection, pulmonary complications, 30-day and 90-day mortality, length of stay, 90-day readmission and reoperation rates) outcomes was performed using a random effects model. Result: Twenty-six non-randomized studies including 2630 patients (950 robotic and 1680 laparoscopic) were included, of which 20% had major robotic liver resection and 14% had major laparoscopic liver resection. Intraoperatively, robotic liver resection was associated with significantly less blood loss (mean: 286 vs 301 mL, p < 0.001) but longer operating time (mean: 281 vs 221 min, p < 0.001). There were no significant differences in conversion rates or transfusion rates between robotic liver resection and laparoscopic liver resection. Postoperatively, there were no significant differences in overall complications, bile leaks, and length of hospital stay between robotic liver resection and laparoscopic liver resection. However, robotic liver resection was associated with significantly lower readmission rates than laparoscopic liver resection (odds ratio: 0.43, p = 0.005). Conclusion: Robotic liver resection appears to offer some advantages compared to conventional laparoscopic surgery, although both techniques appear equivalent. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomized trial comparing both techniques is needed.

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Tranexamic acid use to decrease blood loss in primary shoulder and elbow replacement: A systematic review and meta-analysis

Journal of Orthopaedics ◽

10.1016/j.jor.2021.03.003 ◽

2021 ◽

Author(s):

Richard L. Donovan ◽

Jonny R. Varma ◽

Michael R. Whitehouse ◽

Ashley W. Blom ◽

Setor K. Kunutsor

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Tranexamic Acid ◽

Meta Analysis ◽

Elbow Replacement ◽

Decrease Blood Loss

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The Use of Uterine Tourniquet to Decrease Blood Loss and Transfusion Rate during Myomectomy: A Systematic Review and Meta-Analysis.

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2021.09.293 ◽

2021 ◽

Vol 28 (11) ◽

pp. S148-S149

Author(s):

E. Miazga ◽

S. Benlolo ◽

D. Robertson ◽

A. Nensi

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Meta Analysis ◽

Transfusion Rate ◽

Decrease Blood Loss

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Postoperative morbidity after liver resection- A Systematic review, meta-analysis, and metaregression of factors affecting them.

10.21203/rs.3.rs-644838/v1 ◽

2021 ◽

Author(s):

Bhavin Vasavada ◽

Hardik Patel

Keyword(s):

Systematic Review ◽

Liver Resection ◽

Blood Loss ◽

Postoperative Morbidity ◽

Major Hepatectomy ◽

Meta Analysis ◽

Colorectal Metastasis ◽

Operative Morbidity ◽

Funnel Plot ◽

Open Hepatectomy

Abstract Aim of the study: This systematic review and meta-analysis aimed to analyse post-operative morbidity after liver resection, and also study various factors associated with mortality via metaregression analysis.Material and Methods: PubMed, Cochrane Library, Embase, google scholar, web of science with keywords like ‘liver resection”; ”mortality”;” hepatectomy”. Weighted percentage post-operative morbidities were analysed. Meta-analysis and meta-regression were done by the DerSimonian-Liard random effect model. Heterogeneity was assessed using the Higgins I2 test. Publication bias was assessed using a funnel plot. Funnel plot asymmetry was evaluated by Egger’s test. Morbidity was defined as any postoperative morbidity mentioned.Results: A total of 46 studies was included in the final analysis. Total 45771 patients underwent liver resections. 16111 patients experienced complications during the postoperative period. Weighted post-operative morbidity was 30.2% ( 95 % C.I. 24.8-35.7%). Heterogeneity was high with I2 99.46% and p-value <0.01. On univariate analysis, major liver resections were significantly associated with heterogeneity. (p=0.024). However, residual heterogeneity was still high with I2 98.62%, p<0.001. So, multifactor metaregression analysis major hepatectomy (p<0.001), Open hepatectomy (p=0.001), cirrhotic liver (p=0.002), age (p<0.001), blood loss (p<0.001), and colorectal metastasis (p<0.001) independently associated with postoperative morbidity. Residual heterogeneity was moderate I2= 39.9% and nonsignificant p=0.189.Conclusion: Liver resection is associated with high postoperative morbidity and various factors like major hepatectomy, Open hepatectomy, cirrhotic liver, blood loss, and colorectal metastasis were associated with morbidity and responsible for heterogeneity across the studies.

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Antifibrinolytics reduces blood loss in thoracic surgery: a systematic review and meta‐analysis

ANZ Journal of Surgery ◽

10.1111/ans.16909 ◽

2021 ◽

Author(s):

Lowell Leow ◽

Josiah Ng ◽

Hai Dong Luo ◽

Andrew M. T. L. Choong ◽

Harish Mithiran ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Thoracic Surgery ◽

Meta Analysis

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Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Global Spine Journal ◽

10.1177/21925682211016426 ◽

2021 ◽

pp. 219256822110164

Author(s):

Elsayed Said ◽

Mohamed E. Abdel-Wanis ◽

Mohamed Ameen ◽

Ali A. Sayed ◽

Khaled H. Mosallam ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Interbody Fusion ◽

Revision Rate ◽

Meta Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Operation Time ◽

Controlled Trials ◽

Lumbar Interbody Fusion ◽

Randomized Controlled

Study Design: Systematic review and meta-analysis. Objectives: Arthrodesis has been a valid treatment option for spinal diseases, including spondylolisthesis and lumbar spinal stenosis. Posterolateral and posterior lumbar interbody fusion are amongst the most used fusion techniques. Previous reports comparing both methods have been contradictory. Thus, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to establish substantial evidence on which fusion method would achieve better outcomes. Methods: Major databases including PubMed, Embase, Web of Science and CENTRAL were searched to identify studies comparing outcomes of interest between posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF). We extracted data on clinical outcome, complication rate, revision rate, fusion rate, operation time, and blood loss. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome and the odds ratio with 95% confidence intervals (CIs) for binary outcomes. P < 0.05 was considered significant. Results: We retrieved 8 studies meeting our inclusion criteria, with a total of 616 patients (308 PLF, 308 PLIF). The results of our analysis revealed that patients who underwent PLIF had significantly higher fusion rates. No statistically significant difference was identified in terms of clinical outcomes, complication rates, revision rates, operation time or blood loss. Conclusions: This systematic review and meta-analysis provide a comparison between PLF and PLIF based on RCTs. Although PLIF had higher fusion rates, both fusion methods achieve similar clinical outcomes with equal complication rate, revision rate, operation time and blood loss at 1-year minimum follow-up.

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