637 ANALYSIS OF THE OUTCOMES OF HAND-SEWN COMPARED TO THE STAPLED ANASTOMOSIS AFTER TOTAL GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Fernanda Honório ◽  
João Emílio Pinheiro Filho ◽  
Luca Tristão ◽  
Clara Santos ◽  
Letícia Datrino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Gastrectomy ◽  
Surgical Outcomes ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Mean Difference ◽  
Stapled Anastomosis ◽  
Esophageal Anastomosis

Abstract   The complications related to esophagojejunal anastomosis are among the leading issues in the postoperative period of total gastrectomy. This review aims to evaluate the surgical outcomes of hand-sewn esophageal anastomosis compared to mechanical anastomosis for the reconstruction of total gastrectomy. Methods A systematic review and meta-analysis of comparative studies evaluating hand-sewn and stapled anastomosis was performed. Results A total of 12 studies were selected, comprising 1761 individuals. The operation time was higher in the hand-sewn anastomosis group (mean difference [MD] = 22.13 minutes; 95%CI: 3.97, 40.29). However, the risk for anastomotic fistula was not different between the groups (difference risk [DR] = 0.00; 95%CI: −0.03, 0.03). Also, the rate of intracavitary abscess (DR = -0.02; 95%CI: −0.07, 0.02); the reoperation rate (DR = -0.00; 95%CI: −0.01, 0.01); postoperative complications (DR = 0.12; 95%CI: −0.01, 0.25); postoperative mortality (DR = 0.02; 95%CI: −0.02, 0.06); anastomotic stenosis (DR = -0.01; 95%CI: −0.03, 0.00); and length of hospital stay (mean difference [MD] = 3.52 days; 95%CI: −0.49, 7.53) were no different between groups. Conclusion The results indicate that the hand-sewn and stapled esophageal anastomosis have similar surgical outcomes. Stapled anastomosis has a shorter operation time being.

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

Cancers ◽  
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).

scholarly journals Non-intubated thoracoscopic lobectomies for lung cancer: an exploratory systematic review and meta-analysis

2020 ◽  
Vol 31 (4) ◽  
pp. 499-506 ◽  
Author(s):  
Elena Prisciandaro ◽  
Luca Bertolaccini ◽  
Giulia Sedda ◽  
Lorenzo Spaggiari
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Complication Rates ◽  
Thoracoscopic Lobectomy ◽  
Retrospective Cohort Studies ◽  
The Individual

Abstract Our goal was to assess the safety, feasibility and oncological outcomes of non-intubated thoracoscopic lobectomies for non-small-cell lung cancer (NSCLC). A comprehensive search was performed in EMBASE (via Ovid), MEDLINE (via PubMed) and Cochrane CENTRAL from January 2004 to March 2020. Studies comparing non-intubated anaesthesia with intubated anaesthesia for thoracoscopic lobectomy for NSCLC were included. An exploratory systematic review and a meta-analysis were performed by combining the reported outcomes of the individual studies using a random effects model. For dichotomous outcomes, risk ratios were calculated and for continuous outcomes, the mean difference was used. Three retrospective cohort studies were included, with a total of 204 patients. The comparison between non-intubated and intubated patients undergoing thoracoscopic lobectomy showed no statistically significant differences in postoperative complication rates [risk ratio 0.65, 95% confidence interval (CI) 0.36–1.16; P = 0.30; I2 = 17%], operating times (mean difference −12.40, 95% CI −28.57 to 3.77; P = 0.15; I2 = 48%), length of hospital stay (mean difference −1.13, 95% CI −2.32 to 0.05; P = 0.90; I2 = 0%) and number of dissected lymph nodes (risk ratio 0.92, 95% CI 0.78–1.25; P = 0.46; I2 = 0%). Despite the limitation of only 3 papers included, awake and intubated thoracoscopic lobectomies for resectable NSCLC seem to have comparable perioperative and postoperative outcomes. Nevertheless, the oncological implications of the non-intubated approach should be considered. The long-term benefits for patients with lung cancer need to be carefully assessed.

scholarly journals Timing of cholecystectomy after percutaneous cholecystectomy for acute cholecystitis- A systematic review and meta-analysis

2021 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel
Keyword(s):  
Systematic Review ◽  
Hospital Stay ◽  
Biliary Tract ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Mean Difference ◽  
Complication Rates ◽  
Percutaneous Cholecystostomy ◽  
Timing Of Cholecystectomy

Introduction: There is a controversy about the optimum timing of cholecystectomy after percutaneous cholecystostomy. This systematic review and meta-analysis aimed to evaluate outcomes of early versus late cholecystectomy after percutaneous cholecystectomy. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used. We evaluated cholecystectomy performed at different periods after percutaneous cholecystostomy within 72 hours or later, within or after one week or percutaneous cholecystostomy, within 10 days or after 10 days, less than 2 weeks or more than 2 weeks, less than 4 weeks or more than 4 weeks, less than 8 weeks or more than 8 weeks as per literature. Results: Six studies including 18640 patients were included in the final analysis. There was no difference in overall complications within or after 72 hours cholecystectomy group, but mortality and biliary complications were significantly high in the less than 72 hours group (p=0.05 and 0.0002 respectively). There was no difference in mortality, overall complication, biliary tract complications in less than 1 week versus more than 1 week and less than 10 days versus more than 10 days group. Overall complications were significantly less in the less than 2 weeks group compared to the more than 2 weeks group. There was no difference in mortality and biliary tract complications between less than 2 weeks and more than 2 weeks group. Overall complication rate (risk ratio 0.67, p <0.0001), postoperative mortality (risk ratio 0.46, p=0.003), bile duct injury (risk ratio 0.62, p=0.01) was significantly less in earlier than 4-week group. Hospital stay was not significantly different between less than 4 weeks versus more than 4 weeks group. (Mean difference= -2.74, p=0.12). Ove all complication rates were significantly more in less than 8 weeks group. (Risk ratio 1.07, p=0.01). Hospital stay was significantly less in less than 8 weeks group. (Mean difference 0.87, p=0.01). Conclusion: Early cholecystectomy preferably within 4 weeks after percutaneous cholecystostomy is preferable over late cholecystectomy.

scholarly journals Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Priyam Batra ◽  
Kapil Dev Soni ◽  
Purva Mathur
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Icu Stay ◽  
Length Of Icu Stay

Abstract Introduction Ventilator-associated pneumonia (VAP) is reported as the second most common nosocomial infection among critically ill patients with the incidence ranging from 2 to 16 episodes per 1000 ventilator days. The use of probiotics has been shown to have a promising effect in many RCTs. Our systematic review and meta-analysis were thus planned to determine the effect of probiotic use in critically ill ventilated adult patients on the incidence of VAP, length of hospital stay, length of ICU stay, duration of mechanical ventilation, the incidence of diarrhea, and the incidence of oropharyngeal colonization and in-hospital mortality. Methodology Systematic search of various databases (such as Embase, Cochrane, and Pubmed), published journals, clinical trials, and abstracts of the various major conferences were made to obtain the RCTs which compare probiotics with placebo for VAP prevention. The results were expressed as risk ratios or mean differences. Data synthesis was done using statistical software - Review Manager (RevMan) Version 5.4 (The Cochrane Collaboration, 2020). Results Nine studies met our inclusion criterion and were included in the meta-analysis. The incidence of VAP (risk ratio: 0.70, CI 0.56, 0.88; P = 0.002; I2 = 37%), duration of mechanical ventilation (mean difference −3.75, CI −6.93, −0.58; P 0.02; I2 = 96%), length of ICU stay (mean difference −4.20, CI −6.73, −1.66; P = 0.001; I2 = 84%) and in-hospital mortality (OR 0.73, CI 0.54, 0.98; P = 0.04; I2 = 0%) in the probiotic group was significantly lower than that in the control group. Probiotic administration was not associated with a statistically significant reduction in length of hospital stay (MD −1.94, CI −7.17, 3.28; P = 0.47; I2 = 88%), incidence of oro-pharyngeal colonization (OR 0.59, CI 0.33, 1.04; P = 0.07; I2 = 69%), and incidence of diarrhea (OR 0.59, CI 0.34, 1.03; P = 0.06; I2 = 38%). Discussion Our meta-analysis shows that probiotic administration has a promising role in lowering the incidence of VAP, the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality.

Prognostic Significance of Hyponatremia in Acute Stroke: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 49 (5) ◽  
pp. 531-539
Author(s):  
Shogo Shima ◽  
Yasunari Niimi ◽  
Yosuke Moteki ◽  
Osamu Takahashi ◽  
Shinsuke Sato ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Stroke ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Stroke Patients

<b><i>Objective:</i></b> Hyponatremia is a common electrolyte disorder in patients with stroke, which leads to various fatal complications. We performed a systematic review and meta-analysis to investigate the outcomes of acute stroke patients with hyponatremia. <b><i>Methods:</i></b> We searched MEDLINE, EMBASE, and the Cochrane Library databases for relevant literature in English published up to March 2020. Two review authors independently screened and selected the studies by assessing the eligibility and validity based on the inclusion criteria. Mortality at 90 days was set as the primary end point, and in-hospital mortality and length of hospital stay were set as the secondary end points. We conducted the data synthesis and analyzed the outcomes by calculating the odds ratio (OR) and mean difference. <b><i>Results:</i></b> Of 835 studies, 15 studies met the inclusion criteria (<i>n</i> = 10,745). The prevalence rate of stroke patients with hyponatremia was 7.0–59.2%. They had significantly higher 90-day mortality (OR, 1.73; 95% confidence interval (CI), 1.24–2.42) and longer length of hospital stay (mean difference, 10.68 days; 95% CI, 7.14–14.22) than patients without hyponatremia. Patients with hyponatremia had a higher tendency of in-hospital mortality than those without hyponatremia (OR, 1.61; 95% CI, 0.97–2.69). <b><i>Conclusions:</i></b> The development of hyponatremia in the clinical course of stroke is associated with higher short-term mortality and a longer hospital stay. Although the causal relationship is unclear, hyponatremia could be a significant predictor of poor outcomes after stroke.

Tubeless versus standard percutaneous nephrolithotomy in pediatric patients: a systematic review and meta-analysis

2017 ◽  
Vol 85 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Akbar Nouralizadeh ◽  
Nasser Simforoosh ◽  
Hamidreza Shemshaki ◽  
Mohammad H. Soltani ◽  
Mehdi Sotoudeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Operation Time ◽  
Mean Difference ◽  
Transfusion Rate ◽  
Stone Clearance ◽  
Significant Difference ◽  
Tubeless Pcnl

Background: This systematic review and meta-analysis was designed to evaluate the post-operative outcomes between tubeless and standard percutaneous nephrolithotomy (PCNL) among children. Methods: Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included three trials investigating the outcomes including the length of hospital stay, operation time, hemoglobin decrease, blood transfusion rate, perirenal fluid presence, post-operative fever, stone clearance rate, and the need for a second operation. Results: The patients who underwent tubeless PCNL had shorter length of hospitalization compared to standard PCNLs (mean difference -1.57, 95% confidence interval -3.2 to 0.07, p = 0.06). No significant decrease was detected in hemoglobin after tubeless PCNL compared to standard PCNL (mean difference 0.05, 95% confidence interval -0.03 to 0.13, p = 0.21). There were no significant differences in operation time (p = 0.7), perirenal fluid presence (p = 0.15), post-operative fever (p = 0.72), stone clearance (p = 0.68), and the need for a second operation (p = 0.90). Conclusions: This study showed no significant difference between tubeless and standard PCNLs in children. However, due to the lack of data, the results should be mentioned prudently. Future randomized trials with more sample sizes and longer follow-ups are warranted.

scholarly journals Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis

2018 ◽  
Vol 111 (7) ◽  
pp. 240-252 ◽  
Author(s):  
Jeremy Howick ◽  
Andrew Moscrop ◽  
Alexander Mebius ◽  
Thomas R Fanshawe ◽  
George Lewith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Risk Of Bias ◽  
Mean Difference ◽  
Randomised Trials ◽  
Study Selection ◽  
Protocol Registration ◽  
Small Benefit

Background Practitioners who enhance how they express empathy and create positive expectations of benefit could improve patient outcomes. However, the evidence in this area has not been recently synthesised. Objective To estimate the effects of empathy and expectations interventions for any clinical condition. Design Systematic review and meta-analysis of randomised trials. Data sources Six databases from inception to August 2017. Study selection Randomised trials of empathy or expectations interventions in any clinical setting with patients aged 12 years or older. Review methods Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence using GRADE. Random effects model was used for meta-analysis. Results We identified 28 eligible (n = 6017). In seven trials, empathic consultations improved pain, anxiety and satisfaction by a small amount (standardised mean difference −0.18 [95% confidence interval −0.32 to −0.03]). Twenty-two trials tested the effects of positive expectations. Eighteen of these (n = 2014) reported psychological outcomes (mostly pain) and showed a modest benefit (standardised mean difference −0.43 [95% confidence interval −0.65 to −0.21]); 11 (n = 1790) reported physical outcomes (including bronchial function/ length of hospital stay) and showed a small benefit (standardised mean difference −0.18 [95% confidence interval −0.32 to −0.05]). Within 11 trials (n = 2706) assessing harms, there was no evidence of adverse effects (odds ratio 1.04; 95% confidence interval 0.67 to 1.63). The risk of bias was low. The main limitations were difficulties in blinding and high heterogeneity for some comparisons. Conclusions Greater practitioner empathy or communication of positive messages can have small patient benefits for a range of clinical conditions, especially pain. Protocol registration Cochrane Database of Systematic Reviews (protocol) DOI: 10.1002/14651858.CD011934.pub2.

Tumor characteristics and surgical outcomes of intracranial subependymomas: a systematic review and meta-analysis

2021 ◽  
pp. 1-13
Author(s):  
Barry Ting Sheen Kweh ◽  
Jeffrey Victor Rosenfeld ◽  
Martin Hunn ◽  
Jin Wee Tee
Keyword(s):  
Systematic Review ◽  
Surgical Outcomes ◽  
Postoperative Radiotherapy ◽  
Meta Analysis ◽  
Case Series ◽  
Postoperative Mortality ◽  
Mortality Rates ◽  
Controlled Trials ◽  
Tumor Characteristics ◽  
Male Predominance

OBJECTIVE The tumor characteristics and surgical outcomes of intracranial subependymomas are poorly defined. In this study the authors aimed to provide a comprehensive review of all clinical, pathological, radiological, and surgical aspects of this important neoplasm to inform future management strategies. METHODS A systematic review and meta-analysis of MEDLINE, EMBASE, Cochrane, and Google Scholar databases adherent to PRISMA guidelines was conducted. RESULTS Of the 1145 articles initially retrieved, 24 studies encompassing 890 cases were included. The authors identified 3 retrospective cohort studies and 21 case series, but no controlled trials. Mean age at presentation was 46.7 ± 18.1 years with a male predominance (70.2%). Common sites of tumor origin were the lateral ventricle (44.5%) and fourth ventricle (43.1%). Cumulative postoperative mortality and morbidity rates were 3.4% and 24.3% respectively. Meta-analysis revealed that male sex (HR 3.15, 95% CI 1.39–7.14, p = 0.006) was associated with poorer 5-year overall mortality rates. All-cause mortality rates were similar when performing subgroup meta-analyses for age (HR 0.50, 95% CI 0.03–7.36, p = 0.61), smaller subependymoma size (HR 1.51, 95% CI 0.78–2.92, p = 0.22), gross-total resection (HR 0.65, 95% CI 0.35–1.23, p = 0.18), and receipt of postoperative radiation therapy (HR 0.88, 95% CI 0.27–2.88, p = 0.84). Postoperative Karnofsky Performance Index scores improved by a mean difference of 1.62 ± 12.14 points (p = 0.42). The pooled overall 5-year survival rate was 89.2%, while the cumulative recurrence rate was 1.3% over a median follow-up ranging from 15.3 to 120.0 months. The pure subependymoma histopathological subtype was most prevalent (85.6%), followed by the mixed subependymoma-ependymoma tumor variant (13.7%). CONCLUSIONS Surgical extirpation without postoperative radiotherapy results in excellent postoperative survival and functional outcomes in the treatment of intracranial subependymomas. Aggressive tumor behavior should prompt histological reevaluation for a mixed subependymoma-ependymoma subtype. Further high-quality controlled trials are still required to investigate this rare tumor.

scholarly journals Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Wang Chen ◽  
Jian-Ning Sun ◽  
Ye Zhang ◽  
Yu Zhang ◽  
Xiang-Yang Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Operative Time ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Cochrane Library

Abstract Objective The main objective of our study was to compare the intraoperative and postoperative outcomes of direct anterior approach (DAA) with posterolateral approaches (PLA). Methods We searched Cochrane library, Web of Science, and PubMed for literatures comparing DAA with PLA. On the basis of inclusion and exclusion criteria, relevant literatures were selected. Two members independently screened qualified literatures, evaluated the literature quality, and extracted data information. Results Eighteen randomized controlled trials (RCTs) and non-RCTs totaling 34,873 patients (DAA = 9636, PLA = 25237) were contained in this systematic review and meta-analysis. The results showed that DAA were reduced in terms of length of hospital stay (weighted mean difference (WMD) = −0.43, 95% confidence interval (CI) −0.78 to −0.09, P = 0.01), LLD (WMD = −2.00, 95% CI −2.75 to −1.25, P < 0.00001), PE/DVT (WMD = 0.36, 95% CI 0.15 to 0.85, P = 0.02), dislocation (WMD = 0.42, 95% CI 0.30 to 0.59, P < 0.00001) and visual analog scale (VAS) (WMD = −0.57, 95% CI −0.91 to −0.23, P = 0.0009) compared with PLA; however, DAA compared with the PLA was increasing in terms of operative time (WMD = 14.81, 95% CI 7.18 to 22.44, P = 0.0001), intraoperative blood loss (WMD = 105.13, 95% CI 25.35 to 184.90, P = 0.01), fracture (WMD = 1.46, 95% CI 1.00 to 2.11, P = 0.05), and Harris hip score (HHS) (WMD = 1.19, 95% CI 0.77 to 1.61, P < 0.00001). Conclusions DAA was preferable effectiveness to PLA in early pain relief and functional recovery; however, PLA has a shorter operation time, intraoperative less blood loss and fracture. Trial registration Registration ID, CRD42020151208

scholarly journals Analysis of Results of Hand-Sewn vs Mechanical Esophageal Anastomosis after Total Gastrectomy: A Systematic Review and Meta-analysis.

2021 ◽  
Vol 233 (5) ◽  
pp. S87
Author(s):  
Fernanda C. Cabral ◽  
João Emílio P Filho ◽  
Francisco Tustumi ◽  
Alexandre C. Henriques ◽  
Jaques Waisberg ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Gastrectomy ◽  
Meta Analysis ◽  
Esophageal Anastomosis ◽  
Analysis Of Results
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