Coblation versus Bipolar Diathermy Hemostasis in Pediatric Tonsillectomy Patients: Systematic Review and Meta-Analysis

Objective To compare the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Methods A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and an electronic search of information was conducted to identify all Randomized Controlled Trials (RCTs) comparing the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Intraoperative bleeding, reactionary hemorrhage, delayed hemorrhage and post-operative pain were primary outcome measures. Secondary outcome measures included return to normal diet, effects on tonsillar bed, operation time and administration of analgesia. Fixed and random effects models were used for the analysis. Results Seven studies enrolling 1328 patients were identified. There was a significant difference between coblation and bipolar groups in terms of delayed hemorrhage (Odds Ratio [OR] = 0.25, P = 0.0007) and post-operative pain (standardized mean difference [MD] = -2.13, P = 0.0007). Intraoperative bleeding (MD = -43.26, P = 0.11) and reactionary hemorrhage did not show any significant difference. For secondary outcomes, coblation group had improved outcomes in terms of administration of analgesia, diet and tonsillar tissue recovery and thermal damage. No significant difference was reported in terms of operation time. Conclusions Coblation is a superior option when compared to bipolar technique for pediatric patients undergoing tonsillectomy as it improves post-operative pain and delayed hemorrhage and does not worsen intraoperative bleeding and reactionary hemorrhage.

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Tonsillectomy Outcomes for Coblation Versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis

Ear Nose & Throat Journal ◽

10.1177/0145561321994995 ◽

2021 ◽

pp. 014556132199499

Author(s):

Abdulmalik Alsaif ◽

Mohammad Alazemi ◽

Narvair Kahlar ◽

Mohammad Karam ◽

Ahmad Abul ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Fixed Effects ◽

Meta Analysis ◽

Operation Time ◽

Adult Patients ◽

Secondary Outcome ◽

Bipolar Diathermy ◽

Intraoperative Bleeding ◽

Delayed Hemorrhage

Introduction and Aims: There is no consensus on the optimal tonsillectomy technique in adult patients. The study aims to identify all studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary outcomes were hemorrhage and postoperative pain. Secondary outcome measures included return to theatre, analgesia, intraoperative bleeding, diet, tonsillar healing, and operation time. Fixed-effects modeling was used for the analysis. Results: Six studies were identified enrolling a total of 1824 patients. There were no significant differences in terms of reactionary hemorrhage (OR = 1.81, P = .51), delayed hemorrhage (OR = 0.72, P = .20), or postoperative pain (mean difference = −0.15, P = .45); however, there is a general trend favuring coblation. For secondary outcomes, no significant differences noted in terms of intraoperative bleeding, diet, and cases returning to theatre. Analgesia administration was either insignificant or higher in the coblation group. The coblation group had longer operation time and greater healing effect on tonsillar tissue. Conclusions: There were no significant differences in outcomes for coblation and bipolar diathermy for adult tonsillectomy patients in this systematic review and meta-analysis.

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Tonsillectomy Outcomes for Coblation versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis

10.1101/2020.09.12.20193300 ◽

2020 ◽

Author(s):

Abdulmalik Alsaif ◽

Mohammad Alazemi ◽

Narvair Kahlar ◽

Mohammad Karam ◽

Ahmad Abul ◽

...

Keyword(s):

Systematic Review ◽

Outcome Measures ◽

Fixed Effects ◽

Meta Analysis ◽

Operation Time ◽

Adult Patients ◽

Secondary Outcome ◽

Bipolar Diathermy ◽

Post Operative Pain ◽

Randomised Controlled

Introduction There is no consensus on the most superior tonsillectomy technique in adult patients. Recent trials involving coblation technique have shown promising results. Aim The study aims to compare the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Methods A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a search of electronic information was conducted to identify all Randomised Controlled Trials (RCTs) as well as non-randomised studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Reactionary haemorrhage, delayed haemorrhage and postoperative pain were primary outcome measures. Secondary outcome measures included a return to theatre, administration of analgesia, intraoperative bleeding, diet, the effect on tonsils (degree of healing of tonsillar fossae) and operation time. Fixed effects modelling was used for the analysis. Results Four RCTs and two non-randomised studies were identified enrolling a total of 1824 patients. There were no significant differences between the coblation and bipolar groups in terms of reactionary haemorrhage (Odds Ratio [OR] = 1.81, P = 0.51), delayed haemorrhage (OR = 0.72, P = 0.20) or post-operative pain by day 7 (standardised Mean Difference [MD] = -0.15, P = 0.45). For secondary outcomes, there were no differences noted in terms of intraoperative blood loss, diet and the number of cases returned to theatre. Administration of analgesia was reported to be either insignificant between the two groups or higher in the coblation group Also, the coblation group had longer operation time and greater healing effect on tonsillar tissue. Conclusions Coblation is neither a superior or inferior option when compared to bipolar diathermy used in the current clinical practice for adult patients undergoing tonsillectomy as both techniques have similar haemorrhage rates and post-operative pain whilst also lengthening the operative time in coblation.

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402 A Systematic Review and Meta-Analysis of Autologous vs Titanium Cranioplasty Implants

British Journal of Surgery ◽

10.1093/bjs/znab134.552 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

H Capitelli-McMahon ◽

N Kahlar ◽

S Rahman

Keyword(s):

Systematic Review ◽

Outcome Measures ◽

Meta Analysis ◽

Adverse Outcomes ◽

Titanium Implants ◽

Secondary Outcome ◽

Infection Rates ◽

Optimal Method ◽

Operation Rate ◽

Significant Difference

Abstract Aim: There is currently no gold standard reconstructive material for cranioplasty, with autologous and numerous synthetic materials currently in use. The emerging role of titanium due to its strength and biocompatibility has made it a good option. Titanium has been compared in numerous studies with autologous bone for cranioplasty however there is currently no meta-analysis within the literature to guide craniofacial surgeons on the optimal method. Method A systematic review and meta-analysis was performed as per the PRISMA guidelines and a search of electronic information was conducted to identify all randomised control trials and observational studies comparing autologous implants vs. titanium implants in cranioplasty following craniectomy. Re-operation rates and cosmesis were the primary outcome measures and incidence of complications such as bone resorption and infection were the secondary outcome measures. Results Six studies (n = 1909) were identified. Autologous cranioplasty using bone had a higher re-operation rate (p > 0.007), due to higher bone reabsorption seen in this group. There was no significant difference between the two groups in cosmetic outcome. Both had comparable infection rates (p > 0.18) and costs involved. Conclusions Titanium implants for cranioplasty offer lower re-operation rates compared to autologous based reconstruction without significantly increasing adverse outcomes such as post-operative infection rates or cost.

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The high risk of malarial recurrence in patients with Plasmodium-mixed infection after treatment with antimalarial drugs: a systematic review and meta-analysis

Parasites & Vectors ◽

10.1186/s13071-021-04792-5 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Aongart Mahittikorn ◽

Frederick Ramirez Masangkay ◽

Kwuntida Uthaisar Kotepui ◽

Giovanni De Jesus Milanez ◽

Manas Kotepui

Keyword(s):

Systematic Review ◽

Mixed Infection ◽

Subgroup Analysis ◽

Initial Treatment ◽

Meta Analysis ◽

Antimalarial Drugs ◽

Secondary Outcome ◽

Significant Heterogeneity ◽

Pooled Prevalence ◽

Significant Difference

Abstract Background Malaria mixed infections are often unrecognized by microscopists in the hospitals, and a delay or failure to treat Plasmodium-mixed infection may lead to aggravated morbidity and increased mortality. The present study aimed to quantify the pooled proportion and risk of malarial recurrences after the treatment of Plasmodium-mixed infection. The results of the study may provide benefits in the management of Plasmodium-mixed infection in co-endemic regions. Methods This systematic review and meta-analysis searched the international Prospective Register of Systematic Reviews (PROSPERO; ID = CRD42020199709), MEDLINE, Web of Science, and Scopus for potentially relevant studies in any language published between January 1, 1936, and July 20, 2020, assessing drug efficacy in patients with Plasmodium-mixed infection. The primary outcome was the pooled prevalence of Plasmodium parasitemia after initiating antimalarial treatment for Plasmodium-mixed infection. The secondary outcome was the pooled risk ratio (RR) of malarial recurrence in Plasmodium-mixed infection compared with those in Plasmodium falciparum and Plasmodium vivax mono-infection. The pooled analyses were calculated by random-effects meta-analysis. After the initial treatment in different days of recurrences (≤ 28 days or > 28 days), the risk of Plasmodium parasitemia was compared in subgroup analysis. Results Out of 5217 screened studies, 11 were included in the meta-analysis, including 4390 patients from six countries. The pooled prevalence of all recurrences of Plasmodium-mixed parasitemia was 30% (95% confidence interval (CI) 16–43; I2: 99.2%; 11 studies). The RR of malarial recurrence within 28 days after the initial treatment (clinical treatment failure) of Plasmodium-mixed parasitemia compared with the treatment of P. falciparum was 1.22 (p: 0.029; 95% CI 1.02–1.47; Cochran Q: 0.93; I2: 0%; six studies), while there was no significant difference in the risk of recurrence 28 days after initial treatment compared with the treatment of P. falciparum (p: 0.696, RR: 1.14; 95% CI 0.59–2.18; Cochran Q < 0.05; I2: 98.2%; four studies). The subgroup analysis of antimalarial drugs showed that significant malarial recurrence within 28 days was observed in patients treated with artemisinin-based combination therapies (ACTs) with no significant heterogeneity (p: 0.028, RR: 1.31; 95% CI 1.03–1.66; Cochran Q: 0.834; I2: 0%). Conclusions The present findings showed a high prevalence of malarial recurrence after the initial treatment of Plasmodium-mixed infection. Moreover, significant malaria recurrence of mixed infection occurred within 28 days after treatment with ACTs. Graphic Abstract

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Efficacy and safety of anti-epidermal growth factor receptor agents for the treatment of oesophageal cancer: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-046352 ◽

2021 ◽

Vol 11 (3) ◽

pp. e046352

Author(s):

Lijuan Zhang ◽

Yanli Song ◽

Nan Jiang ◽

Yaqi Huang ◽

Bo Dong ◽

...

Keyword(s):

Systematic Review ◽

Growth Factor ◽

Outcome Measures ◽

Oesophageal Cancer ◽

Meta Analysis ◽

Growth Factor Receptor ◽

Cochrane Library ◽

Secondary Outcome ◽

Efficacy And Safety ◽

Positive Effects

ObjectivesDespite remarkable advances in the treatment of oesophageal cancer (OC), the role of antiepidermal growth factor receptor (anti-EGFR) agents in treating OC remains controversial. Herein, a systematic review and meta-analysis were conducted to elucidate the efficacy and safety of anti-EGFR agents in patients with OC.DesignMeta-analysis of randomised controlled trials (RCTs) identified by searching the PubMed, Embase, Web of Science, ClinicalTrials.gov, Cochrane Library, Chinese Biology Medicine, China National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform databases from inception to December 2019. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.SettingRCTs from any country and healthcare setting.ParticipantsPatients with OC.InterventionsCombination therapy with anti-EGFR agents and conventional treatments versus conventional treatments alone in patients with OC.Primary and secondary outcome measuresOverall survival (OS) and progression-free survival (PFS) were primary outcome measures, and objective response rate (ORR), disease control rate (DCR) and treatment toxicities were secondary outcome measures.ResultsIn total, 25 RCTs comprising 3406 patients with OC were included. Overall, anti-EGFR treatment significantly improved the OS (HR: 0.81, 95% CI 0.74 to 0.89, p<0.00001), ORR (relative risk (RR): 1.33, 95% CI 1.16 to 1.52, p<0.0001) and DCR (RR: 1.22, 95% CI 1.11 to 1.34, p<0.0001) but not PFS (HR: 0.91, 95% CI 0.76 to 1.08, p=0.26). Anti-EGFR treatment was significantly associated with higher incidences of myelosuppression, diarrhoea, acne-like rash and hypomagnesaemia.ConclusionsOverall, anti-EGFR agents have positive effects on OS, the ORR and DCR in OC. However, considering the high incidence of adverse effects, such as myelosuppression, diarrhoea, acne-like rashes and hypomagnesaemia, careful monitoring of patients with OC is recommended during anti-EGFR treatment.Trial registration numberCRD42020169230.

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Efficacy and safety of bevacizumab in the treatment of adult gliomas: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-048975 ◽

2021 ◽

Vol 11 (12) ◽

pp. e048975

Author(s):

Huan Wang ◽

Jianxin Guo ◽

Tianze Wang ◽

Kai Wang ◽

Zhuojun Wu ◽

...

Keyword(s):

Systematic Review ◽

Large Scale ◽

Meta Analysis ◽

Progression Free Survival ◽

Optimal Dose ◽

Secondary Outcome ◽

Efficacy And Safety ◽

Free Survival ◽

Significant Difference ◽

Clinical Centre

ObjectiveTo assess the efficacy and safety of bevacizumab (BEV) in patients with glioma.DesignSystematic review and meta-analysis.ParticipantsAdults aged 18 years and above, whose histology was confirmed to be malignant glioma.Primary and secondary outcome measuresThe main indicators included progression-free survival (PFS) rate and overall survival (OS) rate, and the secondary indicators were adverse reactions.ResultsA total of 11 clinical centre trials were included in this study for meta-analysis, including 2392 patients. The results of the meta-analysis showed that the median PFS rate of the BEV group was significantly higher than that of the non-BEV group (p<0.00001). When comparing PFS between two groups, we found that the PFS in the BEV group was higher than that in the non-BEV group at 6 months (OR 3.31, 95% CI 2.74 to 4.00, p<0.00001), 12 months (OR 2.05, 95% CI 1.70 to 2.49, p<0.00001) and 18 months (OR 1.31, 95% CI 1.02 to 1.69, p=0.03). But at 24 months (OR 0.83, 95% CI 0.50 to 1.37, p=0.47), there was no significant difference between the two groups. At 30 months (OR 0.62, 95% CI 0.39 to 0.97, p=0.04), the PFS of the BEV group was lower than that of the non-BEV group. Moreover, The results showed that BEV had no significant effect on improving OS, but the adverse reaction in BEV group was significantly higher than that in non-BEV group.ConclusionThe evidence suggests that BEV can significantly prolong the PFS of patients with glioma within 18 months and shorten the PFS of patients after 30 months. This limitation may be related to the subgroup of patients, the change of recurrence mode, the optimal dose of drug, the increase of hypoxia, the enhancement of invasiveness and so on. Therefore, it is necessary to carry out more samples and higher quality large-scale research in the future.

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Smaller size is more suitable for pharmacotherapy among undersized abdominal aortic aneurysm: a systematic review and meta-analysis

Vascular Medicine ◽

10.1177/1358863x211061603 ◽

2021 ◽

pp. 1358863X2110616

Author(s):

Takuro Shirasu ◽

Hisato Takagi ◽

Jun Yasuhara ◽

Toshiki Kuno ◽

K Craig Kent ◽

...

Keyword(s):

Systematic Review ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Meta Analysis ◽

Unmet Need ◽

Secondary Outcome ◽

Annual Growth Rate ◽

Abdominal Aortic ◽

Significant Difference ◽

Baseline Diameter

Background: Pharmacotherapy for undersized abdominal aortic aneurysm (AAA) is a clinical unmet need. Randomized controlled trials (RCTs) have failed to show effectiveness despite countless promising data in preclinical studies. We aimed to identify the population with undersized AAAs (30–54 mm) who potentially benefit from pharmacotherapy. Methods: In accordance with the PRISMA statement, we conducted a systematic review and meta-analysis of placebo-controlled RCTs. The primary outcome was mean difference (MD) in annual growth rate (< 0 favors pharmacotherapy), and the secondary outcome was aneurysm-related events (diameters ⩾ 55 mm, ruptures, or referral to surgery). Results: Our search strategy identified eight RCTs (six trials on antibiotics [ABx], two on renin-angiotensin system inhibitors [RAS-I]) with a total of 1325 patients. The mean of baseline diameters ranged from 33.1 mm to 43.1 mm. Neither ABx nor RAS-I showed significant differences in MD. Multivariable random-effects restricted maximum likelihood meta-regression revealed a statistically significant linear relationship between baseline diameter and MD (coefficient 0.15 [95% CI 0.0011, 0.30], p = 0.049) but not for the follow-up period ( p = 0.28) and duration of treatment ( p = 0.11). In line with this result, ABx with baseline diameter < 40 mm significantly reduced MD (−1.03 mm/year [95% CI −1.64, −0.42], p = 0.001) and a borderline significant difference in aneurysm-related events (HR 0.53 [95% CI 0.28, 1.00], p = 0.05), whereas the other groups ⩾ 40 mm never demonstrated effectiveness. Fixed-effect models did not change the results. No evidence of publication bias was detected. Conclusion: Undersized AAAs < 40 mm can potentially benefit from pharmacotherapy. Future RCTs should consider preferentially including undersized AAA with smaller diameters.

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Effect of PTH treatment on bone healing in insufficiency fractures of the pelvis: a systematic review

EFORT Open Reviews ◽

10.1302/2058-5241.6.200029 ◽

2021 ◽

Vol 6 (1) ◽

pp. 9-14

Author(s):

Pernille Bovbjerg ◽

Ditte Høgh ◽

Lonnie Froberg ◽

Hagen Schmal ◽

Moustapha Kassem

Keyword(s):

Systematic Review ◽

Fracture Healing ◽

Outcome Measures ◽

Bone Healing ◽

Meta Analysis ◽

Insufficiency Fracture ◽

Secondary Outcome ◽

Insufficiency Fractures ◽

Patient Reported ◽

Positive Effect

The aging of our society is associated with an increasing number of insufficiency fractures of the pelvis and the current standard of care is pain control and early mobilization. The aim of this study was to explore whether parathyroid hormone (PTH) treatment can support bone healing in these patients. We conducted a systematic review searching the databases PubMed, Embase and Cochrane. Our primary outcome was fracture healing, secondary outcome measures comprised pain, mobility and patient-reported outcome measures (PROMs). Eight articles were included in the qualitative synthesis, of which two were included in a meta-analysis. However, only three studies were comparative including one randomized controlled trial. Fracture healing and reported pain were assessed after eight weeks, and were significantly improved in the group being treated with PTH (p < 0.01) in the meta-analysis. All articles described a positive effect for PTH on fracture healing and pain. Our systematic review indicates that there is a positive effect of PTH treatment on healing and pain in patients with insufficiency fracture in the pelvic ring, but further research is necessary. Cite this article: EFORT Open Rev 2021;6:9-14. DOI: 10.1302/2058-5241.6.200029

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Distal locked versus unlocked intramedullary nailing for stable intertrochanteric fractures, a systematic review and meta-analysis

10.21203/rs.2.18595/v2 ◽

2020 ◽

Author(s):

Yan-Hui Li ◽

Tiecheng Yu ◽

Wenjing Shao ◽

Yanwei Liu ◽

Dong Zhu ◽

...

Keyword(s):

Systematic Review ◽

Intramedullary Nailing ◽

Meta Analysis ◽

Operation Time ◽

Cochrane Library ◽

Functional Score ◽

Transfusion Rate ◽

Intertrochanteric Fractures ◽

Intraoperative Bleeding ◽

Distal Locking

Abstract Background: Intramedullary nails have become the main treatment for intertrochanteric fractures. However, a distal locking procedure during nailing gradually raised controversy. In this study, a systematic review and meta-analysis of clinical trials was performed to summarize existing evidence, aiming to determine the safety and efficacy of distal locking or unlocking in the nailing of stable intertrochanteric fractures. Methods: Appropriate articles were identified using the most common public databases, such as PubMed, Embase, the Cochrane Library, and Google Scholar from the inception of each database to April 2019, without restriction of language, publication date, and considering ongoing trials. Eligible studies were represented by randomized controlled trials or retrospective cohort studies, comparing distal locking and unlocking for the treatment of acute stable intertrochanteric fractures in adult patients. Information regarding methodological quality, patient demographics, and clinical outcomes were extracted independently by two reviewers. Subsequently, patients were divided into a locking and unlocking group.Results: This study included 9 articles, comprising a total of 1978 patients with a similar baseline. The results showed that the unlocking group had a shorter operation time, less intraoperative bleeding, lower transfusion rate, and less thigh pain after the treatment of femoral intertrochanteric fracture when compared with the distal locking group. No significant differences were observed in safety-related outcomes, including mortality, infection rate, cutting out, loss of reduction, backing out of lag screws, cephalic screw breakage, nail breakage, and peri-implant fractures between the two groups. In addition, efficacy-related outcomes including nonunion, delayed healing rates, and the Harris functional score were not significantly different between the two groups. Conclusions: Our pooled analysis demonstrated that distal unlocking of stable intertrochanteric fractures can shorten the operation time, reduce intraoperative bleeding, and reduce the blood transfusion rate. The use of locked or unlocked intramedullary nailing does not affect long-term outcomes regarding complications and function.

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Distal locked versus unlocked intramedullary nailing for stable intertrochanteric fractures, a systematic review and meta-analysis

10.21203/rs.2.18595/v1 ◽

2019 ◽

Author(s):

Yan-Hui Li ◽

Tiecheng Yu ◽

Wenjing Shao ◽

Yanwei Liu ◽

Dong Zhu ◽

...

Keyword(s):

Systematic Review ◽

Intramedullary Nailing ◽

Meta Analysis ◽

Operation Time ◽

Cochrane Library ◽

Functional Score ◽

Transfusion Rate ◽

Intertrochanteric Fractures ◽

Intraoperative Bleeding ◽

Distal Locking

Abstract Background: Intramedullary nails have become the main treatment for intertrochanteric fractures. However, distal locking procedure during nailing gradually raised controversy. A systematic review and meta-analysis of clinical trials was performed to summarize the existing evidence with the aim at determining the safety and efficacy of distal locking or unlocking in the nailing of stable intertrochanteric fractures. Methods: Appropriate articles were identified using the most common public databases such as PubMed, Embase, the Cochrane Library, and Google Scholar from the inception of each database to April 2019, without restriction of language, publication date, and also considering ongoing trials. Eligible studies were represented by randomized controlled trials or retrospective cohort studies comparing distal locking with unlocking for the treatment of acute stable intertrochanteric fractures in adult patients. Information regarding the methodological quality, patient demographics and all clinical outcomes were extracted independently by two reviewers. Patients were then divided into locking and unlocking group. Results: This study included 9 articles, a total of 1978 patients with a similar baseline. The results showed that the unlocking group had shorter operation time, less intraoperative bleeding, lower transfusion rate, and less thigh pain after the treatment of femoral intertrochanteric fracture compared with the distal locking group. No significant difference was found in safety-related outcomes including mortality, infection rate, cutting out, loss of reduction, backing out of lag screws, cephalic screw breakage, nail breakage, and peri-implant fractures between the two groups. Efficacy-related outcomes including nonunion, delayed healing rates, and Harris functional score were also not significantly different between the two groups. Conclusions: Our pooled analysis demonstrated that the distal unlocking of the stable intertrochanteric fractures can shorten the operation time, reduce intraoperative bleeding, and reduce the blood transfusion rate. The use of locked or unlocked intramedullary nailing does not affect long-term outcomes in terms of complications and function.

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