The impact of surgeon volume and hospital volume on postoperative mortality and morbidity after hip fractures: A systematic review

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

Clinical Therapeutics ◽

10.1016/j.clinthera.2018.10.022 ◽

2019 ◽

Vol 41 (1) ◽

pp. 138-154.e4 ◽

Cited By ~ 10

Author(s):

Ke Peng ◽

Fu-hai Ji ◽

Hua-yue Liu ◽

Juan Zhang ◽

Qing-cai Chen ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Postoperative Mortality ◽

Mortality And Morbidity

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Impact of the Type of Anesthesia on Outcome after Elective Endovascular Aortic Aneurysm Repair: Literature Review

Vascular ◽

10.2310/6670.2008.00053 ◽

2008 ◽

Vol 16 (6) ◽

pp. 340-345 ◽

Cited By ~ 17

Author(s):

Umar Sadat ◽

David G. Cooper ◽

Jonathan H. Gillard ◽

Stewart R. Walsh ◽

Paul D. Hayes

Keyword(s):

Hospital Stay ◽

General Anesthesia ◽

Endovascular Aneurysm Repair ◽

Postoperative Mortality ◽

Postoperative Outcomes ◽

Mortality And Morbidity ◽

Icu Stay ◽

Locoregional Anesthesia ◽

Aneurysm Repair ◽

The Impact

The type of anesthesia used during aneurysm repair affects postoperative outcomes for the patient. Although endovascular aneurysm repair (EVAR) appears to improve surgical outcomes, by convention, general anesthesia remains predominantly used. The aim of this study was to compare the impact of the type of anesthesia (ie, locoregional versus general anesthesia) on the outcomes following EVAR. A literature search was carried out using the PubMed search engine to find relevant published articles that compared locoregional and general anesthesia in patients undergoing EVAR. The review of the selected studies showed that although patients in the locoregional group were less medically fit compared with those in the general anesthesia group, there was a reduction in the cardiovascular support required during and after the surgery, postoperative hospital stay, intensive care unit (ICU) stay, and postoperative mortality and morbidity. Although there is no level 1 evidence for or against locoregional anesthesia in EVAR, conventionally, EVAR has been performed under general anesthesia. But this is rooted in tradition rather than evidence. This review suggests that locoregional anesthesia can improve postoperative outcomes following EVAR by reducing hospital stay, ICU stay, mortality, and morbidity, although other factors may also have some influence.

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Radical cystectomy: The significance of hospital volume and surgeon volume. A systematic review and recommendations by the EAU MIBC Guideline Panel

European Urology Open Science ◽

10.1016/s2666-1683(20)33803-9 ◽

2020 ◽

Vol 19 ◽

pp. e1790-e1791

Author(s):

H.M. Bruins ◽

E. Veskimae ◽

V. Hernandez ◽

Y. Neuzillet ◽

M. Rouanne ◽

...

Keyword(s):

Systematic Review ◽

Radical Cystectomy ◽

Hospital Volume ◽

Surgeon Volume ◽

Guideline Panel

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Pneumonia Is Associated with Increased Mortality in Hospitalized COPD Patients: A Systematic Review and Meta-Analysis

Respiration ◽

10.1159/000510615 ◽

2021 ◽

Vol 100 (1) ◽

pp. 64-76

Author(s):

Yan Yu ◽

Wei Liu ◽

Hong-Li Jiang ◽

Bing Mao

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Hospital Stay ◽

Readmission Rate ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mortality And Morbidity ◽

Icu Stay ◽

Copd Patients ◽

The Impact

Background: Patients with chronic obstructive pulmonary disease (COPD) are at a heightened risk of pneumonia. Whether coexisting community-acquired pneumonia (CAP) can predict increased mortality in hospitalized COPD patients is still controversial. Objective: This systematic review and meta-analysis aims to assess the association between CAP and mortality and morbidity in COPD patients hospitalized for acute worsening of respiratory symptoms. Methods: In this review, cohort studies and case-control studies investigating the impact of CAP in hospitalized COPD patients were retrieved from 4 electronic databases from inception until December 2019. Methodological quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale. The primary outcome was mortality. The secondary outcomes included length of hospital stay, need for mechanical ventilation, intensive care unit (ICU) admission, length of ICU stay, and readmission rate. The Mantel-Haenszel method and inverse variance method were used to calculate pooled relative risk (RR) and mean difference (MD), respectively. Results: A total of 18 studies were included. The presence of CAP was associated with higher mortality (RR = 1.85; 95% CI: 1.50–2.30; p < 0.00001), longer length of hospital stay (MD = 1.89; 95% CI: 1.19–2.59; p < 0.00001), more need for mechanical ventilation (RR = 1.48; 95% CI: 1.32–1.67; p < 0.00001), and more ICU admissions (RR = 1.58; 95% CI: 1.24–2.03; p = 0.0002) in hospitalized COPD patients. CAP was not associated with longer ICU stay (MD = 5.2; 95% CI: −2.35 to 12.74; p = 0.18) or higher readmission rate (RR = 1.02; 95% CI: 0.96–1.09; p = 0.47). Conclusion: Coexisting CAP may be associated with increased mortality and morbidity in hospitalized COPD patients, so radiological confirmation of CAP should be required and more attention should be paid to these patients.

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Effect of Extending the Original CROSS Criteria on Tumor Response to Neoadjuvant Chemoradiotherapy in Esophageal Cancer Patients: A National Multicenter Cohort Analysis

Annals of Surgical Oncology ◽

10.1245/s10434-020-09372-y ◽

2020 ◽

Cited By ~ 1

Author(s):

Helena Hong Wang ◽

◽

Ellen C. de Heer ◽

Jan Binne Hulshoff ◽

Gursah Kats-Ugurlu ◽

...

Keyword(s):

Esophageal Cancer ◽

Cohort Analysis ◽

Locally Advanced ◽

Pathologic Complete Response ◽

Neoadjuvant Chemoradiotherapy ◽

Postoperative Mortality ◽

Complete Response ◽

Mortality And Morbidity ◽

The Cross ◽

The Impact

Abstract Background Extending the original criteria of the Chemoradiotherapy for Oesophageal Cancer followed by Surgery Study (CROSS) in daily practice may increase the treatment outcome of esophageal cancer (EC) patients. This retrospective national cohort study assessed the impact on the pathologic complete response (pCR) rate and surgical outcome. Patients and Methods Data from EC patients treated between 2009 and 2017 were collected from the national Dutch Upper Gastrointestinal Cancer Audit database. Patients had locally advanced EC (cT1/N+ or cT2-4a/N0-3/M0) and were treated according to the CROSS regimen. CROSS (n = 1942) and the extended CROSS (e-CROSS; n = 1359) represent patients fulfilling the original or extended CROSS criteria, respectively. The primary outcome was total pCR (ypT0N0), while secondary outcomes were local esophageal pCR (ypT0), surgical radicality, and postoperative morbidity and mortality. Results Overall, CROSS and e-CROSS did not differ in total or local pCR rate, although a trend was observed (23.2% vs. 20.4%, p = 0.052; and 26.7% vs. 23.8%, p = 0.061). When stratifying by histology, the pCR rate was higher in the CROSS group compared with e-CROSS in squamous cell carcinomas (48.2% vs. 33.3%, p = 0.000) but not in adenocarcinomas (16.8% vs. 16.9%, p = 0.908). Surgical radicality did not differ between groups. Postoperative mortality (3.2% vs. 4.6%, p = 0.037) and morbidity (58.3% vs. 61.8%, p = 0.048) were higher in e-CROSS. Conclusion Extending the CROSS inclusion criteria for neoadjuvant chemoradiotherapy in routine clinical practice of EC patients had no impact on the pCR rate and on radicality, but was associated with increased postoperative mortality and morbidity. Importantly, effects differed between histological subtypes. Hence, in future studies, we should carefully reconsider who will benefit most in the real-world setting.

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PP8 Trauma and the obesity epidemic: a systematic review of the impact of obesity on trauma mortality and morbidity

Emergency Medicine Journal ◽

10.1136/emermed-2019-999abs.8 ◽

2019 ◽

Vol 36 (10) ◽

pp. e5.1-e5

Author(s):

Simon Mayer ◽

Sumitra Lahiri ◽

Joseph Rowles

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Injury Severity ◽

Traumatic Injury ◽

Strong Relationship ◽

Normal Weight ◽

The Body ◽

Trauma Patients ◽

Mortality And Morbidity ◽

The Impact

BackgroundTrauma and obesity are both current global epidemics. A simple way to measure the body habitus of patients, to identify the overweight or obese is via the internationally recognized calculation of body mass index (BMI). The primary aim of this systematic review is to assess the mortality rate of those patients with a BMI > 30 kg/m2 in relation to traumatic injury and secondly to assess the effect of those patients with BMI > 30 kg/m2 upon the length of stay in hospital with regards to traumatic injury.MethodA systematic review of the literature was conducted via an internet search of databases and hand searching of references in identified publications from 1st January 1990 to 17th February 2018. Data was extracted from identified publications to include odds ratios of mortality and total length of stay in hospital (days) for patients with a BMI >30 kg/m2 from included studies when compared to patients with a BMI <24.9 kg/m2.ResultsA total of 23 studies met the inclusion criteria. 32, 378 patients were admitted to hospital with a BMI >30 kg/m2 and recorded injury severity score (ISS). Data collated identified BMI >30 kg/m2 OR 1.66 (95% CI 0.75 – 4.2) vs BMI <24.9 kg/m2 OR 0.93 (95% CI 0.82–1.5) to suffer mortality. ISS, BMI >30 kg/m2–19.93 vs 22.3 respectively. Furthermore, those categorised as BMI >30 kg/m2 have 3.78 additional days in the hospital compared to those defined as normal weight.ConclusionThis systematic review presents a strong relationship of increased mortality and complications in trauma patients with BMI >30 kg/m2. Complications are suggestive of those who have a BMI >30 kg/m2 are more likely to suffer detrimental effects following trauma predominantly due to pre-existing unknown co-morbidities. Although, the direct relationship between obesity, trauma and mortality is not fully understood at present and requires more research.

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Neuraxial Anesthesia and Postoperative Mortality and Morbidity

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0042 ◽

2018 ◽

pp. 225-229

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Postoperative Morbidity ◽

Postoperative Mortality ◽

Mortality And Morbidity ◽

Neuraxial Blockade ◽

Study Results ◽

Wide Range

This case focuses on the effects of neuraxial blockade on postoperative mortality and morbidity by asking the question: What are the effects of neuraxial blockade with epidural or spinal anesthesia on postoperative morbidity and mortality? This systematic review examined all trials with randomization to intraoperative neuraxial blockade (with epidural or spinal anesthesia) or no neuraxial blockade for which data were available before January 1, 1997. The study included 9,559 patients over 141 included trials. Study results demonstrated that neuraxial blockade reduces morbidity and postoperative complications in a wide range of patients, independent of surgery type, choice of neuraxial technique, or use of general anesthesia.

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