Pathway for Enhanced Recovery after Spinal Surgery-A Systematic Review of Evidence for use of Individual Components

Background Enhanced recovery in spinal surgery (ERSS) has shown promising improvements in clinical and economical outcomes. We have proposed an ERSS pathway based on societal recommendations and qualitative reviews. We aimed to delineate the clinical efficacy of individual pathway components in ERSS through a systematic narrative review. Methods We included systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled studies, and observational studies in adults and pediatric patients evaluating any one of the 22 pre-defined care components. Our primary outcomes included all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). We searched the following databases (1990 onwards) MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers independently screened all citations, full-text articles, and abstracted data. A narrative synthesis was provided. Where applicable, we constructed Evidence Profile (EP) tables for each individual element. Due to clinical and methodological heterogeneity, we did not conduct a meta-analyses. Confidence in cumulative evidence for each component of the pathway was classified according to the GRADE system. Results We identified 5423 relevant studies excluding duplicates as relating to the 22 pre-defined components of enhanced recovery in spinal surgery. We included 664 studies in the systematic review. We found specific evidence within the context of spinal surgery for 14/22 proposed components. Evidence was summarized in EP tables for 12/22 components. We performed thematic synthesis without EP for 6/22 elements. We identified appropriate societal guidelines for the remainder of the components. Discussion We identified the following components with high quality of evidence as per GRADE system: pre-emptive analgesia, peri-operative blood conservation (antifibrinolytic use), surgical site preparation and antibiotic prophylaxis. There was moderate level of evidence for implementation of prehabilitation, minimally invasive surgery, multimodal perioperative analgesia, intravenous lignocaine and ketamine use as well as early mobilization. This review allows for the first formalized evidence-based unified protocol in the field of ERSS. Further studies validating the multimodal ERSS framework are essential to guide the future evolution of care in patients undergoing spinal surgery.

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Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

BMC Anesthesiology ◽

10.1186/s12871-021-01281-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ana Licina ◽

Andrew Silvers ◽

Harry Laughlin ◽

Jeremy Russell ◽

Crispin Wan

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Spinal Surgery ◽

Enhanced Recovery ◽

Grade System ◽

Cochrane Library ◽

Randomized Controlled ◽

Randomized Controlled Studies ◽

Patient Reported

AbstractBackgroundEnhanced recovery in spinal surgery (ERSS) has shown promising improvements in clinical and economical outcomes. We have proposed an ERSS pathway based on available evidence. We aimed to delineate the clinical efficacy of individual pathway components in ERSS through a systematic narrative review.MethodsWe included systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled studies, and observational studies in adults and pediatric patients evaluating any one of the 22 pre-defined components. Our primary outcomes included all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). Following databases (1990 onwards) were searched: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two authors screened the citations, full-text articles, and extracted data. A narrative synthesis was provided. We constructed Evidence Profile (EP) tables for each component of the pathway, where appropriate information was available. Due to clinical and methodological heterogeneity, we did not conduct a meta-analyses. GRADE system was used to classify confidence in cumulative evidence for each component of the pathway.ResultsWe identified 5423 relevant studies excluding duplicates as relating to the 22 pre-defined components of enhanced recovery in spinal surgery. We included 664 studies in the systematic review. We identified specific evidence within the context of spinal surgery for 14/22 proposed components. Evidence was summarized in EP tables where suitable. We performed thematic synthesis without EP for 6/22 elements. We identified appropriate societal guidelines for the remainder of the components.ConclusionsWe identified the following components with high quality of evidence as per GRADE system: pre-emptive analgesia, peri-operative blood conservation (antifibrinolytic use), surgical site preparation and antibiotic prophylaxis. There was moderate level of evidence for implementation of prehabilitation, minimally invasive surgery, multimodal perioperative analgesia, intravenous lignocaine and ketamine use as well as early mobilization. This review allows for the first formalized evidence-based unified protocol in the field of ERSS.Further studies validating the multimodal ERSS framework are essential to guide the future evolution of care in patients undergoing spinal surgery.

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Patient-Reported Outcome Measures in Cystic Fibrosis: Protocol for a Systematic Review (Preprint)

10.2196/preprints.15467 ◽

2019 ◽

Author(s):

Irushi Ratnayake ◽

Susannah Ahern ◽

Rasa Ruseckaite

Keyword(s):

Systematic Review ◽

Cystic Fibrosis ◽

Outcome Measures ◽

Systematic Reviews ◽

Pediatric Patients ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Cochrane Library ◽

Patient Reported

BACKGROUND Patients with cystic fibrosis (CF) can struggle with burdensome symptoms and treatment regimens that negatively affect every aspect of their life. As physiological parameters can fail to capture these complications, the assessment of health-related quality of life (HRQOL) has gained prominence. HRQOL can be measured using standardized patient questionnaires called patient-reported outcome measures (PROMs). The Australian Cystic Fibrosis Data Registry (ACFDR) collects clinical data on adult and pediatric patients with CF. The incorporation of PROMs into the ACFDR would enable monitoring of HRQOL trends, benchmarking of HRQOL outcomes, and support of HRQOL research in CF. OBJECTIVE Prior to incorporation of a PROM in the ACFDR, this systematic review was planned to evaluate whether any suitable PROMs are currently being used for CF. METHODS This systematic review will be conducted in compliance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. MEDLINE, EMBASE, Scopus, CINAHL (Cumulative Index of Nursing and Allied Health Literature), PsycINFO, and Cochrane Library databases were searched for articles published between January 2009 and February 2019 on the use of PROMs to measure HRQOL in adult and pediatric patients with CF. Study designs such as observational studies, reviews and validation studies were included. Studies describing randomized controlled trials, dissertations, books, guideline statements, and abstracts were excluded. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist was used to assess the methodological quality of included studies. A descriptive synthesis of the results will be undertaken in line with the outcomes of this study. RESULTS As of July 2019, the search has been conducted and 4530 records were screened. After two phases of screening, 97 studies were included in the final review and subjected to data extraction. Reviewers are currently in the process of critical appraisal. CONCLUSIONS This review will identify any PROM(s) that may be used to measure HRQOL in the ACFDR. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42019126931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=126931

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Patient-Reported Outcome Measures in Cystic Fibrosis: Protocol for a Systematic Review

JMIR Research Protocols ◽

10.2196/15467 ◽

2020 ◽

Vol 9 (5) ◽

pp. e15467

Author(s):

Irushi Ratnayake ◽

Susannah Ahern ◽

Rasa Ruseckaite

Keyword(s):

Systematic Review ◽

Cystic Fibrosis ◽

Outcome Measures ◽

Systematic Reviews ◽

Pediatric Patients ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Cochrane Library ◽

Patient Reported

Background Patients with cystic fibrosis (CF) can struggle with burdensome symptoms and treatment regimens that negatively affect every aspect of their life. As physiological parameters can fail to capture these complications, the assessment of health-related quality of life (HRQOL) has gained prominence. HRQOL can be measured using standardized patient questionnaires called patient-reported outcome measures (PROMs). The Australian Cystic Fibrosis Data Registry (ACFDR) collects clinical data on adult and pediatric patients with CF. The incorporation of PROMs into the ACFDR would enable monitoring of HRQOL trends, benchmarking of HRQOL outcomes, and support of HRQOL research in CF. Objective Prior to incorporation of a PROM in the ACFDR, this systematic review was planned to evaluate whether any suitable PROMs are currently being used for CF. Methods This systematic review will be conducted in compliance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. MEDLINE, EMBASE, Scopus, CINAHL (Cumulative Index of Nursing and Allied Health Literature), PsycINFO, and Cochrane Library databases were searched for articles published between January 2009 and February 2019 on the use of PROMs to measure HRQOL in adult and pediatric patients with CF. Study designs such as observational studies, reviews and validation studies were included. Studies describing randomized controlled trials, dissertations, books, guideline statements, and abstracts were excluded. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist was used to assess the methodological quality of included studies. A descriptive synthesis of the results will be undertaken in line with the outcomes of this study. Results As of July 2019, the search has been conducted and 4530 records were screened. After two phases of screening, 97 studies were included in the final review and subjected to data extraction. Reviewers are currently in the process of critical appraisal. Conclusions This review will identify any PROM(s) that may be used to measure HRQOL in the ACFDR. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019126931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=126931

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Lumbar Roll Usage While Sitting Reduces the Forward Head Posture in Healthy Individuals: A Systematic Review with Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105171 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5171

Author(s):

Yusuke Handa ◽

Kenya Okada ◽

Hiroshi Takasaki

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grade System ◽

Cochrane Library ◽

Forward Head Posture ◽

Quality Of Evidence ◽

Head Posture ◽

Head Extension ◽

The Cochrane Library

This systematic review and meta-analysis investigated whether the use of a lumbar roll reduced forward head posture (FHP) while sitting among individuals with or without musculoskeletal disorders. EMBASE, MEDLINE, and the Cochrane Library were systematically searched from their inception to August 2020. The quality of evidence for variables used in the meta-analysis was determined using the GRADE system. Five studies satisfied the criteria for data analysis. All studies included individuals without any spinal symptoms. Data from five studies on neck angle showed a statistically significant (p = 0.02) overall effect (standardized mean difference (SMD) = 0.77), indicating a lesser neck flexion angle while sitting with a lumbar roll than without it. Data from two studies on head angle showed a statistically significant (p = 0.04) overall effect (SMD = 0.47), indicating a lesser head extension angle while sitting with a lumbar roll than without it. In each meta-analysis, the quality of evidence was very low in the GRADE system. The use of a lumbar roll while sitting reduced FHP among individuals without spinal symptoms.

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Communication in decision aids for stage I–III colorectal cancer patients: a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-044472 ◽

2021 ◽

Vol 11 (4) ◽

pp. e044472

Author(s):

Saar Hommes ◽

Ruben Vromans ◽

Felix Clouth ◽

Xander Verbeek ◽

Ignace de Hingh ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Decision Making ◽

Systematic Reviews ◽

Decision Aids ◽

Specific Treatment ◽

Cochrane Library ◽

Plain Language ◽

Patient Decision

ObjectivesTo assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted.DesignSystematic review.Data sourcesDAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources.Eligibility criteriaDAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I–III.Data extraction and synthesisAfter the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist.ResultsIn total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language.ConclusionsBoth instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.

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Generic Patient-Reported Outcomes and Outcome Measures: A Systematic Review Study Protocol

10.1101/2021.05.28.21257980 ◽

2021 ◽

Author(s):

Yuki Seidler ◽

Erika Mosor ◽

Margaret R Andrews ◽

Carolina Watson ◽

Nick Bott ◽

...

Keyword(s):

Systematic Review ◽

Outcome Measures ◽

Systematic Reviews ◽

Patient Reported Outcomes ◽

Outcome Measurement ◽

Meta Analysis ◽

Patient Reported Outcome ◽

Cochrane Library ◽

Screening Process ◽

Patient Reported

Background: Patient-reported outcomes (PROs) are an essential part of health outcome measurement and vital to patient-centricity and valued-based care. Several international consortia have developed core outcome sets and many of them include PROs. PROs are measured by patient-reported outcome measures (PROMs). PROs and PROMs can be generic or specific to certain diseases or conditions. While the characteristics of generic PROs and PROMs are well recognised as widely relevant and applicable across different domains, diseases and conditions, there is a lack of knowledge on the types of PROs measured by generic PROMs. We also do not know in which disease areas generic PROs and PROMs are commonly used. To date, there has been no systematic review solely focusing on generic PROMs, what they measure and their areas of application. Objectives: This systematic review will identify core PROs measured by generic PROMs used in adult populations and the areas in which they are applied. Methods: We will conduct a systematic review of reviews. The screening process and the reporting will comply with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 Statement. We will use four databases, Medline [PubMed], CINHAL [Ebsco], Cochrane [Cochrane Library], and PsycINFO [Ovid], and reports from international consortia. Inclusion criteria are systematic reviews, meta-analysis or patient-reported outcome sets developed by international consortia reporting on generic PROMs in adult populations. Articles primarily focusing on patient-reported experience measures (PREMs), children or adolescents, or those not written in English will be excluded. Risk of bias will be assessed by checking if the included articles comply with established guidelines for systematic reviews such as the PRISMA statement. We will extract generic PROMs and PROs measured by these PROMs, and the areas applied from the selected articles and reports. Extracted data and information will be quantitatively and qualitatively synthesised without statistical interference. The quality of the synthesised evidences will be assessed by clarifying the strengths, limitations and possible biases in our review.

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PP109 Use Of Speech Recognition In Medical Reports: A Systematic Review

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318002489 ◽

2018 ◽

Vol 34 (S1) ◽

pp. 107-107

Author(s):

Thomas Poder ◽

Véronique Déry ◽

Jean-Francois Fisette

Keyword(s):

Systematic Review ◽

Speech Recognition ◽

Systematic Reviews ◽

Grey Literature ◽

Medical Doctor ◽

Cochrane Library ◽

Medical Specialties ◽

Medical Reports ◽

End Use

Introduction:Speech recognition is increasingly used in medical reporting. The aim of this article is to identify in the literature the advantages and weaknesses of this technology, as well as barriers and facilitators to its implementation.Methods:A systematic review of systematic reviews has been conducted in PubMed, Scopus, Cochrane Library and Center for Reviews and Dissemination up to August 2017. The grey literature has also been consulted. The quality of systematic reviews has been assessed with the AMSTAR checklist. Inclusion criteria were to use speech recognition for medical reporting (front or back-end). A Survey has also been conducted in Quebec, Canada, to identify the dissemination of this technology in this province, as well as the factors of success or failure in its implementation.Results:Five systematic reviews were identified. These reviews indicated a high level of heterogeneity across studies. The quality of the studies reported was generally poor. Speech recognition is not as accurate as human transcription but can dramatically reduce the turnaround times for reporting. In front-end use, medical doctors need to spend more time for dictation and correction than with human transcription. With speech recognition, major errors can be up to three times more frequent. In back-end use, a potential increase in the productivity of transcriptionist is noted.Conclusions:Speech recognition offers some advantages for medical reporting, the main one being a reduction in turnaround times. However, these advantages are challenged by an increased burden for medical doctor and risks of additional errors in medical reports. It is also hard to identify for which medical specialties and which clinical activities the use of speech recognition will be the most beneficial.

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Telemonitoring Interventions in COPD Patients: Overview of Systematic Reviews

BioMed Research International ◽

10.1155/2020/5040521 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Xuanlin Li ◽

Yang Xie ◽

Hulei Zhao ◽

Hailong Zhang ◽

Xueqing Yu ◽

...

Keyword(s):

Quality Of Life ◽

Exercise Capacity ◽

Systematic Reviews ◽

Methodological Quality ◽

Grade System ◽

Cochrane Library ◽

Exacerbation Rate ◽

Copd Patients

Objective. The role of telemonitoring interventions (TIs) for chronic obstructive pulmonary disease (COPD) has been studied in many systematic reviews (SRs) and meta-analyses (MAs), but robust conclusions have not been reached due to wide variations in scopes, qualities, and outcomes. The aim of this overview was to determine the effectiveness of TIs on COPD patients. Methods. PubMed, EMBASE, Web of Science, and Cochrane Library were searched for all reviews on the topic of TI in treating COPD from inception to July 8, 2019, without restrictions on language. According to the inclusion and exclusion criteria, the retrieved literature studies were screened to select SRs and MAs of randomized control trials (RCTs) that evaluated the effects of TIs in COPD patients. The methodological quality of SRs and MAs was assessed with the AMSTAR-2 tool, and the strength of evidence was assessed with the grades of recommendations, assessment, development, and evaluation (GRADE) system for concerned outcomes in terms of mortality, quality of life (SGRQ total scores), exercise capacity (6MWD), and exacerbation-related outcomes (hospitalizations, exacerbation rate, and emergency room visits). Results. Our overview included eight SRs and MAs published in 2011 to 2019, from 95 RCTs involving 10632 participants. After strict evaluation by the AMSTAR-2 tool, 75% of the SRs and MAs in this overview had either low or critically low methodological quality. The effects of TIs for COPD on mortality, quality of life, exercise capacity, and exacerbation-related outcomes are limited, and all of these outcomes scored either low or very low quality of evidence on the GRADE system. Conclusions. There might be insufficient evidence to support the effectiveness of TIs for COPD currently, but the results of this overview should be interpreted dialectically and prudently, and the role of TIs in COPD needs further exploration.

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Effectiveness and Safety of Preoperative Oral Carbohydrates in Enhanced Recovery after Surgery Protocols for Patients with Diabetes Mellitus: A Systematic Review

BioMed Research International ◽

10.1155/2020/5623596 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Li-Na Ge ◽

Lin Wang ◽

Feng Wang

Keyword(s):

Diabetes Mellitus ◽

Randomized Controlled Trials ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Biomedical Literature ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Patients With Diabetes

To evaluate the necessity and safety of preoperative oral carbohydrates in enhanced recovery after surgery (ERAS) protocols for diabetes mellitus patients. We searched PubMed, EMBASE, the Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG databases for articles published through September 2018. We used the Cochrane risk-of-bias tool to assess the methodological quality of included studies. Literature screening, data extraction, and quality evaluation were performed independently by two investigators. Of the 6328 retrieved articles, five eligible randomized controlled trials were included. Two were from China and three were from Germany, Sweden, and Canada. Preoperative oral carbohydrates may facilitate control of preoperative blood glucose, improve postoperative insulin resistance in diabetes patients, and decrease the occurrence of adverse reactions. However, the overall quality of the included studies was low. The available evidence shows that preoperative oral carbohydrates are probably beneficial for patients with diabetes mellitus. High-quality, large randomized controlled trials are needed to verify our findings and provide quantitative results.

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Enhanced recovery after surgery in pediatric spine surgery: systematic review

Hirurgiâ pozvonočnika ◽

10.14531/ss2021.4.6-27 ◽

2021 ◽

Vol 18 (4) ◽

pp. 6-27

Author(s):

Aleksandr Petrovich Saifullin ◽

Andrei Evgenievich Bokov ◽

Alexander Yakovlevich Aleynik ◽

Yulia Alexandrovna Israelyan ◽

Sergey Gennadevich Mlyavykh

Keyword(s):

Systematic Review ◽

Children And Adolescents ◽

Spinal Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Operation Time ◽

Early Mobilization ◽

Cochrane Library ◽

Control Group ◽

Review Of The Literature

Objective. To conduct a systematic review of the literature on the use of enhanced recovery after surgery (ERAS) protocols in spinalsurgery of children and adolescents to determine the existing evidence of the effectiveness of ERAS implementation in clinical practice.Material and Methods. The authors conducted a systematic review of the literature on ERAS in spinal and spinal cord surgery in children and adolescents selected in the databases of medical literature and search resources of PUBMED/MEDLINE, Google Scholar, Cochrane Library and eLibrary according to the PRISMA guidelines and the PICOS inclusion and exclusion criteria.Results. A total of 12 publications containing information on the treatment of 2,145 children, whose average age was 14.0 years (from 7.2 to 16.1), were analyzed. In the reviewed publications, the average number of key elements of the ERAS program was 9 (from 2 to 20), and a total of 23 elements used in spinal surgery in children and adolescents were identified. The most commonly used elements were preoperative education and counseling, prevention of infectious complications and intestinal obstruction, multimodal analgesia, refusal of routine use of drains, nasogastric probes and urinary catheters, standardized anesthesia protocol, early mobilization and enteral loading. The introduction of the ERAS protocol into clinical practice allowed to reduce the complication rate in comparison with the control group by 8.2 %(from 2 to 19 %), the volume of blood loss by 230 ml (from 75 to 427 ml), the operation time by 83 minutes (from 23 to 144 minutes), theduration of hospitalization by 1.5 days (from 0.5 to 3 days) and the total cost of treatment by 2258.5 dollars (from 860 to 5280 dollars).The ERAS program was implemented in pediatric clinics in the USA (75 %), France (8 %) and Canada (17 %).Conclusion. The conducted systematic review of the literature allows us to conclude that the technology of enhanced recovery after surgery is a promising technology that improves surgical outcomes and is applicable in pediatric practice. There is a significant shortage of published studies evaluating the implementation of ERAS in pediatric surgical practice in general, and in spinal surgery in particular, which requires further prospective randomized studies to evaluate ERAS in spinal surgery in children and adolescents.

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