scholarly journals P-P40 Can trainees safely perform pancreatoduodenectomy? A systematic review, meta-analysis and risk-adjusted analysis of post-operative pancreatic fistula

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Rupaly Pande ◽  
James Halle-Smith ◽  
Tom Thorne ◽  
James Hodson ◽  
Keith J Roberts ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Fistula ◽  
Retrospective Cohort ◽  
Meta Analysis ◽  
Multivariable Analysis ◽  
Objective Evaluation ◽  
Risk Scores ◽  
Case Selection ◽  
Surgical Trainees ◽  
Cusum Analysis

Abstract Background The complexity of pancreaticoduodenectomy (PD) and fear of morbidity, particularly post-operative pancreatic fistula (POPF), can be a barrier to surgical trainees gaining operative experience.  Objective to compare the POPF rate following PD by trainees or established surgeons. Methods A systematic review of the literature was performed using PRISMA guidelines, with differences in POPF rates after PD between trainee-led vs. consultant/attending surgeons pooled using meta-analysis. Variation in rates of POPF was further explored using risk-adjusted outcomes using published risk scores and CUSUM analysis in a retrospective cohort.    Results Across 14 cohorts included in the meta-analysis, trainees tended towards a lower, but non significant rate of All-POPF (odds ratio [OR]: 0.77, p = 0.45) and clinically relevant (CR)-POPF (OR: 0.69, p = 0.37). However, there was evidence of case selection, with trainees being less likely to operate on patients with a pancreatic duct width <3mm (OR: 0.45, p = 0.05). Similarly, analysis of a retrospective cohort (N = 756 cases) found patients operated by trainees to have significantly lower predicted All-POPF (median: 20 vs. 26%, p < 0.001) and CR-POPF (7 vs. 9%, p = 0.020) rates than consultant/attending surgeons, based on pre-operative risk scores. After adjusting for this on multivariable analysis, the risks of All-POPF (OR: 1.18, p = 0.604) and CR-POPF (OR: 0.85, p = 0.693) remained similar after PD by trainee or consultant/attending surgeons. Conclusions PD, when performed by trainees, is associated with acceptable outcomes. There is evidence of case selection among patients undergoing surgery by trainees; hence, risk adjustment provides a critical tool for the objective evaluation of performance. 

scholarly journals P-P38 External validation of post-operative pancreatic fistula prediction scores in pancreatoduodenectomy: a systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Rupaly Pande ◽  
James Halle-Smith ◽  
Liam Phelan ◽  
Tom Thorne ◽  
James Hodson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Fistula ◽  
Risk Score ◽  
Predictive Accuracy ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
External Validation ◽  
Risk Scores ◽  
Clinical Validity ◽  
Future Studies

Abstract Background Multiple risk scores claim to predict the probability of post-operative pancreatic fistula (POPF) after pancreatoduodenectomy. It is unclear which scores have undergone external validation which score is the most accurate.  Objective: To identify risk scores and assess the clinical validity of these scores.  Methods Areas under receiving operator characteristic curve (AUROCs) were extracted from studies that performed external validation of POPF risk scores. These were pooled for each risk score, using intercept-only random-effects meta-regression models.  Results Systematic review identified 34 risk scores, of which six had been subjected to external validation, and so were included in the meta-analysis, namely the Tokyo (N = 2 validation studies), Birmingham (N = 5), FRS (N = 19), a-FRS (N = 12), m-FRS (N = 3) and ua-FRS (N = 3) scores.  The overall predictive accuracies were found to be similar for all six scores, with pooled AUROCs of 0.61, 0.70, 0.71, 0.70, 0.70 and 0.72, respectively. Considerably heterogeneity was observed, with I2 statistics ranging from 52.1-88.6%. Conclusions Most risk scores lack external validation, their predictive accuracies were limited and similar across risk scores. Consensus is needed for which score to use in clinical practice. Due to the limited predictive accuracy, future studies to derive a more accurate risk score are warranted. 

Impact of neoadjuvant therapy on post‐operative pancreatic fistula: a systematic review and meta‐analysis

2020 ◽  
Vol 90 (11) ◽  
pp. 2201-2210 ◽  
Author(s):  
Sivesh K. Kamarajah ◽  
James R. Bundred ◽  
Charles Boyle ◽  
June Oo ◽  
Sanjay Pandanaboyana ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Fistula ◽  
Neoadjuvant Therapy ◽  
Meta Analysis

scholarly journals Parenteral versus enteral nutrition for pancreatic fistula: a systematic review and meta-analysis

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S293
Author(s):  
P. Serrano ◽  
T. McKechnie ◽  
S. Lee ◽  
Y. Lee ◽  
K. Tywonek ◽  
...  
Keyword(s):  
Systematic Review ◽  
Enteral Nutrition ◽  
Pancreatic Fistula ◽  
Meta Analysis

Tu1366 ENDOSCOPIC ULTRASOUND VS PERCUTANEOUS MANAGEMENT OF POST-OPERATIVE PANCREATIC FISTULA: A SYSTEMATIC REVIEW AND META-ANALYSIS

2019 ◽  
Vol 89 (6) ◽  
pp. AB591-AB592
Author(s):  
Babu P. Mohan ◽  
Mohammed Shakhatreh ◽  
Sushma Dugyala ◽  
Vaishali Geedigunta ◽  
Ashwini Gadalay ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Fistula ◽  
Endoscopic Ultrasound ◽  
Meta Analysis

scholarly journals Maternal Exposure to Alcohol and Low Birthweight: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 41 (05) ◽  
pp. 333-347
Author(s):  
Priscilla Perez da Silva Pereira ◽  
Fabiana Araújo Figueiredo Da Mata ◽  
Ana Claudia Morais Godoy Figueiredo ◽  
Roberta Borges Silva ◽  
Maurício Gomes Pereira
Keyword(s):  
Systematic Review ◽  
Alcohol Consumption ◽  
Cohort Studies ◽  
Retrospective Cohort ◽  
Literature Search ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Case Control ◽  
Case Control Studies ◽  
Retrospective Cohort Studies

Objective To investigate the relationship between maternal exposure to alcohol and low birthweight (LBW). Methods The literature search was performed in January 2017 using the following electronic databases: Medline, Embase, LILACS, SciELO, Web of Science, Scopus, CINHAL, Proquest, and PsychInfo. The search strategy used the following terms: alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol addiction/use/abuse/consumption, light/moderate/social/low drinking, low birthweight, case-control studies, retrospective studies, and cohort studies. No restrictions regarding language or publication date were considered. The literature search yielded 2,383 articles, and after screening and eligibility assessment, 39 articles were included in the systematic review, and 38 studies were included in the meta-analysis. Results Maternal alcohol consumption was associated with LBW among retrospective cohort studies (relative risk [RR] = 1.37; 95%CI [confidence interval]:1.10–1.77; I2 = 98.4%; p < 0.01). Prospective cohort studies (RR = 1.11; 95%CI: 0.98–1.25; I2 = 81.5%; p < 0.01), and case-control studies (odds ration [OR] = 1.16; 95%CI: 0.68–1.97; I2 = 61.2%; p = 0.05) showed no association between alcohol and LBW. No publication bias was identified, and the meta-regression showed that the sample size influenced the high heterogeneity among retrospective cohort studies. The subgroup analysis showed differences in association between groups when compared by sample size, type of adjustment, or crude measures and publication year. Conclusions We have not found an association between alcohol consumption during gestation and LBW in the analysis in all of the subgroups. In addition, we have found a high heterogeneity between the primary studies, which is related to methodological differences in the conduction of these studies.

scholarly journals Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis

2020 ◽  
Vol 112 (4) ◽  
pp. 1069-1079
Author(s):  
Radhini Karunaratne ◽  
Jonathan P Sturgeon ◽  
Rajvi Patel ◽  
Andrew J Prendergast
Keyword(s):  
Systematic Review ◽  
Hiv Infection ◽  
Severe Acute Malnutrition ◽  
Meta Analysis ◽  
Multivariable Analysis ◽  
Acute Malnutrition ◽  
Cochrane Library ◽  
Inpatient Mortality ◽  
Baseline Factors ◽  
The Cochrane Library

ABSTRACT Background Malnutrition underlies 45% of under-5 deaths globally. Severe acute malnutrition (SAM) is the most serious form of undernutrition, characterized by wasting with or without edema. Mortality remains high (10%–40%) among children requiring hospitalization for complicated SAM. Objectives We aimed to systematically document the factors independently associated with inpatient mortality in children with SAM. Methods Embase, Ovid MEDINE, the Cochrane Library, and clinicaltrials.gov were searched for articles published between January 2000 and January 2020, using a prespecified protocol. Eligible studies included children aged ≤59 mo hospitalized with SAM and used multivariable analysis to assess the baseline factors independently associated with inpatient mortality. Random-effects meta-analysis, stratified by the stated measure of effect, was used where &gt;20% of studies included the same factor in analyses. Results Twenty-eight of 1432 studies fulfilled inclusion criteria: 19 studies included all children with SAM and 9 included specific subgroups of children with SAM. All 19 main studies were from 8 countries across Africa, with a median of 400 children/study. The mean inpatient mortality was 15.7% (95% CI: 10.4%, 21.0%) and HIV prevalence ranged from 2.1% to 51%. Nine factors were included in the meta-analysis, stratified by HR and OR. HIV infection (HR: 4.32; 95% CI: 2.31, 8.08), weight-for-height z score (WHZ) (OR: 0.44; 95% CI: 0.24, 0.80), diarrhea (HR: 2.84; 95% CI: 1.40, 5.75), pneumonia (HR: 1.89; 95% CI: 1.19, 3.02), presence of shock (HR: 3.67; 95% CI: 2.24, 6.03), and lack of appetite (HR: 2.16; 95% CI: 1.48, 3.16) were associated with increased mortality, whereas child age and sex were not. The association between edema and mortality was difficult to ascertain from the available studies. Conclusions HIV infection, diarrhea, pneumonia, shock, lack of appetite, and lower WHZ are independent predictors of inpatient mortality in children with SAM. These factors may help to risk-stratify children being hospitalized with complicated SAM. This systematic review/meta-analysis protocol was registered at www.crd.york.ac.uk/prospero as CRD42019152267.

Sign in / Sign up

Export Citation Format

Share Document