Reduction in Mortality following Elective Major Hip and Knee Surgery: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 119 (04) ◽  
pp. 668-674 ◽  
Author(s):  
Ke Xu ◽  
Noel Chan ◽  
Quazi Ibrahim ◽  
Paul Kruger ◽  
Smita Sinha ◽  
...  
Keyword(s):  
Study Design ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Relative Reduction ◽  
Mortality Reduction ◽  
Mortality Risks ◽  
The Past ◽  
Operative Care ◽  
Major Orthopaedic Surgery ◽  
Hip And Knee Surgery

Background Systematic reviews reporting time trends in mortality following major orthopaedic surgery are few and have limitations. They reported on only a fraction (< 15%) of the available data and did not investigate potential causes of the reduction in mortality. Methods We searched PubMed for randomized trials and observational studies, published between 1950 and 2016, reporting on mortality within 3 months of elective total hip and knee replacement (THR/TKR). Mortality risks were estimated for each 5-year interval using a Poisson regression model and presented by study design and mode of prophylaxis. To estimate the mortality reduction unrelated to anti-thrombotic use, we performed a pooled analysis of four thromboprophylaxis strategies for which data spanned five decades. Results We identified 255 eligible studies, which documented 31,604 deaths among 6,293,954 patients, and found a consistent decline in mortality irrespective of study design and mode of prophylaxis. Mortality declined from 1.15% pre-1980 to 0.24% post-2000, a 78.7% relative risk reduction (95% confidence interval [CI]: 74.7–82.1%) in randomized and cohort studies. Furthermore, our data showed a 74.4% (95% CI: 68.7–79.0%) relative reduction in mortality independent of the methods of prophylaxis, thereby indicating that improvements in peri-operative care unrelated to anti-thrombotic prophylaxis played a major role in such reduction. Conclusion Mortality following elective THR/TKR has markedly declined over the past 50 years and is now low irrespective of which prophylactic agent is being used. Although anti-thrombotic prophylaxis may have contributed, other improvements in peri-operative care played a major role in the mortality reduction.

scholarly journals 165 A Review of The Current Literature on LMWH Administered at Different Times in Relation to MOS (Major Orthopaedic Surgery): Assessment of The Safety and Efficacy of The Different Proposed Strategies

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Placella ◽  
V Pace ◽  
P Antinolfi ◽  
V Salini
Keyword(s):  
Meta Analysis ◽  
Convincing Evidence ◽  
Just In Time ◽  
Medical Complications ◽  
Randomized Controlled ◽  
The Past ◽  
Cochrane Database ◽  
Major Orthopedic Surgery ◽  
Major Orthopaedic Surgery ◽  
The One

Abstract Nowadays venous VTE represents an important perioperative and postoperative complication in patients undergoing elective Major Orthopedic Surgery (MOS). There are significant discrepancies between clinical practice, international recommendations, and published guidelines. Although thromboembolic events may be less common these days than in the past, they can still lead to serious medical complications. Therefore, most patients undergoing MOS procedures are provided with one of the thromboprophylactic treatments. The optimum timing of LMWH administrations remains debated. Customized structured electronic searches in PubMed and Cochrane database. Meta-Analysis, Randomized Controlled Trials, Systematic Reviews on different strategies of the use of LMWH for MOS. Studies on prophylactic regimens showed that subcutaneous LMWH plays a key role in the management of thromboprophylaxis in MOS. However, some controversies still stand. Among those most relevant, it remains unclear whether to start thromboprophylaxis before or after MOS to better balance the risks of clotting and bleeding. With regards to different times of LMWH administration, there is no convincing evidence that starting prophylaxis 12 hours preoperatively is associated with lower risks of VTE compared to prophylaxis started 12 to 24 hours postoperatively. Furthermore, it seems that the most safe and efficient LMWH regimen is the one called “Just-in-time” (LMWH started 6 hours post-op).

scholarly journals The safety of MSC therapy over the past 15 years: a meta-analysis

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Yang Wang ◽  
Hanxiao Yi ◽  
Yancheng Song
Keyword(s):  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Web Of Science ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
High Quality ◽  
Serious Adverse Events ◽  
The Past ◽  
Clinical Investigations ◽  
Different Populations

Abstract Background Despite increasing clinical investigations emphasizing the safety of mesenchymal stem cell (MSC) therapy in different populations with different diseases, no article has recently reviewed the adverse events in all populations. Aim To evaluate the safety of MSC therapy in all populations receiving MSC therapy and explore the potential heterogeneities influencing the clinical application of MSCs. Methods The PubMed, Embase, Web of Science and Scopus databases were searched from onset until 1 March 2021. Results All adverse events are displayed as odds ratios (ORs) and 95% CIs (confidential intervals). In total, 62 randomized clinical trials were included that enrolled 3546 participants diagnosed with various diseases (approximately 20 types of diseases) treated with intravenous or local implantation versus placebo or no treatment. All studies were of high quality, and neither serious publication bias nor serious adverse events (such as death and infection) were discovered across the included studies. The pooled analysis demonstrated that MSC administration was closely associated with transient fever (OR, 3.65, 95% CI 2.05–6.49, p < 0.01), administration site adverse events (OR, 1.98, 95% CI 1.01–3.87, p = 0.05), constipation (OR, 2.45, 95% CI 1.01–5.97, p = 0.05), fatigue (OR, 2.99, 95% CI 1.06–8.44, p = 0.04) and sleeplessness (OR, 5.90, 95% CI 1.04–33.47, p = 0.05). Interestingly, MSC administration trended towards lowering rather than boosting the incidence rate of arrhythmia (OR, 0.62, 95% CI 0.36–1.07, p = 0.09). Conclusions Conclusively, MSC administration was safe in different populations compared with other placebo modalities.

Clinical Lessons of MSC Therapy Over the Past 15 Years: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Yang Wang ◽  
Hanxiao Yi ◽  
Yancheng Song
Keyword(s):  
Odds Ratio ◽  
Randomized Clinical Trials ◽  
Web Of Science ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Site Conditions ◽  
Serious Adverse Events ◽  
The Past ◽  
Clinical Investigations ◽  
Different Populations

Abstract Background: Despite increasing clinical investigations in emphasizing the safety of MSC therapy in different populations with different diseases, recently, no article overall reviewed the side events in all populations.Aim: To evaluate the safety of MSC therapy in all populations receiving MSC therapy and explore the potential heterogeneities influencing the clinical application of MSC.Methods: The databases of PubMed, Embase, Web of Science and Scopus were searched from onset until March 1st, 2021. Results: All side events were displayed as odds ratio (OR) and 95% CI (confidential intervals). Totally, 62 randomized clinical trials (RCTs) that enrolled 3546 participants diagnosed with various diseases (about 20 kinds of diseases) treated with intravenous or local implantation vs placebo, or no treatment were included. All studies were high quality, neither serious publication bias nor serious adverse events (such as death and infection) were discovered across included studies. The pooled analysis demonstrated that MSC administration was extremely associated with transient fever [OR, 3.65, 95% CI: 2.05 to 6.49, p<0.01], administration site conditions [OR, 1.98, 95% CI: 1.01 to 3.87, p=0.05], constipation [OR, 2.45, 95% CI: 1.01 to 5.97, p=0.05], fatigue [OR, 2.99, 95% CI: 1.06 to 8.44, p=0.04], and sleeplessness [OR, 5.90, 95% CI: 1.04 to 33.47, p=0.05]. Interestingly, MSC administration trended to lower rather than boost the incidence rate of arrhythmia [OR, 0.62, 95% CI: 0.36 to 1.07, p=0.09]. Conclusions: Conclusively, MSC administration was safe in different populations compared with the other placebo modalities.

scholarly journals Meta-Analysis of Empirical Estimates of Loss-Aversion

2020 ◽  
Author(s):  
Alexander L. Brown ◽  
Taisuke Imai ◽  
Ferdinand Vieider ◽  
Colin Camerer
Keyword(s):  
Behavioral Economics ◽  
Study Design ◽  
Loss Aversion ◽  
Large Scale ◽  
Meta Analysis ◽  
The Past ◽  
P Loss ◽  
Empirical Estimates ◽  
The Mean

Loss aversion is one of the most widely used concepts in behavioral economics. We conduct a large-scale interdisciplinary meta-analysis, to systematically accumulate knowledge from numerous empirical estimates of the loss aversion coefficient reported during the past couple of decades. We examine 607 empirical estimates of loss aversion from 150 articles in economics, psychology, neuroscience, and several other disciplines. Our analysis indicates that the mean loss aversion coefficient is between 1.8 and 2.1. We also document how reported estimates vary depending on the observable characteristics of the study design.

The Ego Could Be Depleted, Providing Initial Exertion Is Depleting

2017 ◽  
Vol 48 (4) ◽  
pp. 242-245 ◽  
Author(s):  
Junhua Dang ◽  
Ying Liu ◽  
Xiaoping Liu ◽  
Lihua Mao
Keyword(s):  
Stroop Task ◽  
Meta Analysis ◽  
Ego Depletion ◽  
Current Experiment ◽  
The Past ◽  
Depletion Effect

Abstract. The ego depletion effect has been examined by over 300 independent studies during the past two decades. Despite its pervasive influence, recently this effect has been severely challenged and asserted to be a fake. Based on an up-to-date meta-analysis that examined the effectiveness of each frequently used depleting task, we preregistered the current experiment with the aim to examine whether there would be an ego depletion effect when the Stroop task is used as the depleting task. The results demonstrated a significant ego depletion effect. The current research highlights the importance of the depleting task’s effectiveness. That is to say, the “ego” could be “depleted,” but only when initial exertion is “depleting.”

scholarly journals Performance of the ESC 0/3-hour algorithm for rapid triage of myocardial infarction: systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Chiang ◽  
C.H Chiang ◽  
G.H Lee ◽  
C.C Lee
Keyword(s):  
Myocardial Infarction ◽  
Predictive Value ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Public Institution ◽  
Systematic Evaluation ◽  
Funding Source ◽  
Cochrane Central Register ◽  
Comparative Performance ◽  
Rule Out

Abstract Objective The European Society of Cardiology (ESC) 0/3-hour algorithm is one of the most widely strategies used for rule-out or rule-in of acute myocardial infarction (AMI). However, a systematic evaluation of its performance has not been conducted. Furthermore, recent studies showed that the 0/3-hour algorithm is non-superior to the 0/1-hour algorithm. Purpose This study aims to summarize the safety and efficacy of the 0/3-hour algorithm and its comparative performance with the 0/1-hour algorithm. Methods We conducted literature search on PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published between 1 January 2008 and 31 May 2019. A bivariate random-effects meta-analysis was used to estimate the primary and secondary outcomes, defined as index myocardial infarction and triage efficacy, major adverse cardiac event (MACE) or mortality at 30 days, respectively. Results A total of 10,832 patients from 9 studies with a pooled AMI prevalence of 16% were analyzed. The 0/3-hour algorithm ruled out 69% of the patients with a pooled sensitivity of 94.2% [95% CI: 87.6%–97.4%] and negative predictive value of 98.6% [95% CI: 97.0%–99.4%]; 17% of the patients were ruled in with a pooled specificity of 94.9% [95% CI: 88.6%–97.8%] and positive predictive value of 72.9% [95% CI: 54.6%–85.7%]. The 30-day mortality and 30-day MACE for patients that were ruled out were 0.0% [95% CI: 0.0%–0.0%] and 1.4% [95% CI: 0.9%–2.0%], respectively. In a pooled analysis of 3 cohorts, the 0/3-hour algorithm had a non-superior sensitivity compared with the 0/1-hour algorithm (94.4% [95% CI: 87.0%–97.7%] vs. 98.4% [95% CI: 95.4%–99.7%]). The 0/3-hour algorithm also had a similar rule-out efficacy compared with the 0/1-hour algorithm (52% [95% CI: 39%–65%] vs. 53% [95% CI: 42%–64%]). Conclusion The widely used 0/3-hour algorithm has sensitivity substantially below the consensus goal of 99% and may not be sufficiently safe for triage of myocardial infarction. Furthermore, the 0/3-hour algorithm is not superior to the 0/1-hour algorithm despite the additional triage time. Performance of ESC 0/3-hour algorithm Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Taiwan National Ministry of Science and Technology Grants

scholarly journals A heart failure phenotype stratified model for predicting 1-year mortality in patients admitted with acute heart failure: results from an individual participant data meta-analysis of four prospective European cohorts

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yuntao Chen ◽  
Adriaan A. Voors ◽  
Tiny Jaarsma ◽  
Chim C. Lang ◽  
Iziah E. Sama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Decision Making ◽  
Cox Model ◽  
Meta Analysis ◽  
Prognostic Index ◽  
Individual Participant Data ◽  
Mortality Risks ◽  
Baseline Mortality ◽  
Individual Participant ◽  
Stratified Model

Abstract Background Prognostic models developed in general cohorts with a mixture of heart failure (HF) phenotypes, though more widely applicable, are also likely to yield larger prediction errors in settings where the HF phenotypes have substantially different baseline mortality rates or different predictor-outcome associations. This study sought to use individual participant data meta-analysis to develop an HF phenotype stratified model for predicting 1-year mortality in patients admitted with acute HF. Methods Four prospective European cohorts were used to develop an HF phenotype stratified model. Cox model with two rounds of backward elimination was used to derive the prognostic index. Weibull model was used to obtain the baseline hazard functions. The internal-external cross-validation (IECV) approach was used to evaluate the generalizability of the developed model in terms of discrimination and calibration. Results 3577 acute HF patients were included, of which 2368 were classified as having HF with reduced ejection fraction (EF) (HFrEF; EF < 40%), 588 as having HF with midrange EF (HFmrEF; EF 40–49%), and 621 as having HF with preserved EF (HFpEF; EF ≥ 50%). A total of 11 readily available variables built up the prognostic index. For four of these predictor variables, namely systolic blood pressure, serum creatinine, myocardial infarction, and diabetes, the effect differed across the three HF phenotypes. With a weighted IECV-adjusted AUC of 0.79 (0.74–0.83) for HFrEF, 0.74 (0.70–0.79) for HFmrEF, and 0.74 (0.71–0.77) for HFpEF, the model showed excellent discrimination. Moreover, there was a good agreement between the average observed and predicted 1-year mortality risks, especially after recalibration of the baseline mortality risks. Conclusions Our HF phenotype stratified model showed excellent generalizability across four European cohorts and may provide a useful tool in HF phenotype-specific clinical decision-making.

scholarly journals Prevalence of potential respiratory symptoms in survivors of hospital admission after coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

2021 ◽  
Vol 18 ◽  
pp. 147997312110022
Author(s):  
Kevin Cares-Marambio ◽  
Yessenia Montenegro-Jiménez ◽  
Rodrigo Torres-Castro ◽  
Roberto Vera-Uribe ◽  
Yolanda Torralba ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chest Pain ◽  
Hospital Admission ◽  
Respiratory Symptoms ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Data Synthesis ◽  
Recent Onset ◽  
Persistent Symptoms

Knowledge on the sequelae of Coronavirus Disease 2019 (COVID-19) remains limited due to the relatively recent onset of this pathology. However, the literature on other types of coronavirus infections prior to COVID-19 reports that patients may experience persistent symptoms after discharge. To determine the prevalence of respiratory symptoms in survivors of hospital admission after COVID-19 infection. A living systematic review of five databases was performed in order to identify studies which reported the persistence of respiratory symptoms in COVID-19 patients after discharge. Two independent researchers reviewed and analysed the available literature, and then extracted and assessed the quality of those articles. Of the 1,154 reports returned by the initial search nine articles were found, in which 1,816 patients were included in the data synthesis. In the pooled analysis, we found a prevalence of 0.52 (CI 0.38–0.66, p < 0.01, I 2 = 97%), 0.37 (CI 0.28–0.48, p < 0.01, I 2 = 93%), 0.16 (CI 0.10–0.23, p < 0.01, I 2 = 90%) and 0.14 (CI 0.06–0.24, p < 0.01, I 2 = 96%) for fatigue, dyspnoea, chest pain, and cough, respectively. Fatigue, dyspnoea, chest pain, and cough were the most prevalent respiratory symptoms found in 52%, 37%, 16% and 14% of patients between 3 weeks and 3 months, after discharge in survivors of hospital admission by COVID-19, respectively.

scholarly journals SARS-CoV-2 genome and antibodies in breastmilk: a systematic review and meta-analysis

2021 ◽  
pp. fetalneonatal-2020-321074
Author(s):  
Faith Zhu ◽  
Carlos Zozaya ◽  
Qi Zhou ◽  
Charmaine De Castro ◽  
Prakesh S Shah
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Study Design ◽  
Web Of Science ◽  
Meta Analysis ◽  
Respiratory Support ◽  
Common Finding ◽  
Rt Pcr

ObjectiveTo systematically review and meta-analyse the rate of SARS-CoV-2 genome identification and the presence of SARS-CoV-2 antibodies in breastmilk of mothers with COVID-19.DesignA systematic review of studies published between January 2019 and October 2020 without study design or language restrictions.SettingData sourced from Ovid Embase Classic+Embase, PubMed, Web of Science, Scopus, relevant bibliographies and the John Hopkins University COVID-19 database.PatientsMothers with confirmed COVID-19 and breastmilk tested for SARS-CoV-2 by RT-PCR or for anti-SARS-CoV-2 antibodies.Main outcome measuresPresence of SARS-CoV-2 genome and antibodies in breastmilk.ResultsWe included 50 articles. Twelve out of 183 women from 48 studies were positive for SARS-CoV-2 genome in their breastmilk (pooled proportion 5% (95% CI 2% to 15%; I2=48%)). Six infants (50%) of these 12 mothers tested positive for SARS-CoV-2, with one requiring respiratory support. Sixty-one out of 89 women from 10 studies had anti-SARS-CoV-2 antibody in their breastmilk (pooled proportion 83% (95% CI 32% to 98%; I2=88%)). The predominant antibody detected was IgA.ConclusionsSARS-CoV-2 genome presence in breastmilk is uncommon and is associated with mild symptoms in infants. Anti-SARS-CoV-2 antibodies may be a more common finding. Considering the low proportion of SARS-CoV-2 genome detected in breastmilk and its lower virulence, mothers with COVID-19 should be supported to breastfeed.

scholarly journals The association between Helicobacter pylori and obesity: a systematic review and meta-analysis of case–control studies

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Ali Baradaran ◽  
Hojat Dehghanbanadaki ◽  
Sara Naderpour ◽  
Leila Mohammadi Pirkashani ◽  
Abdolhalim Rajabi ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Case Control ◽  
Case Control Studies ◽  
Newcastle Ottawa Scale ◽  
Prevalence Of Obesity ◽  
Quantitative Analyses ◽  
H Pylori

Abstract Introduction The relationship between H. pylori infection and obesity development has remained controversial among various studies. The aim of this study was to clarify the pooled effect of H. pylori infection on the development of obesity and vice versa. Methods We searched international databases including Medline (PubMed), Web of sciences, Scopus, EMBASE, Cochrane, Ovid, and CINHAL to retrieve all case–control studies reporting the effect of H. pylori on obesity and vice versa, which had been published in English between January 1990 and June 2019. The quality of included studies was assessed by the Modified Newcastle–Ottawa Scale for Case–Control studies. The logarithm of the odds ratio (OR) and its standard error was used for the meta-analysis. Results Eight case–control studies with 25,519 participants were included for qualitative and quantitative analyses. The pooled analysis showed that obese participants had a higher risk of H. pylori infection than lean participants with an odds ratio of 1.46 (95%CI: 1.26, 1.68). Also, the pooled analysis revealed that participants infected by H. pylori had a higher risk of obesity than non-infected participants with an odds ratio of 1.01 (95%CI: 1.01, 1.02). Conclusion The results of this meta-analysis showed that there was a positive correlation between the risk of H. pylori infection and the prevalence of obesity development. Thus, H. pylori positive patients were more likely to be obese, and obese individuals had higher risks of H. pylori infection.

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