Sternal closure with single compared with double or figure of 8 wires in obese patients following cardiac surgery: A systematic review and meta‐analysis

2021 ◽  
Vol 36 (3) ◽  
pp. 1072-1082
Author(s):  
Ahmed M. A. Shafi ◽  
Eyad Abuelgasim ◽  
Biyaser Abuelgasim ◽  
Sashini Iddawela ◽  
Amer Harky
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Meta Analysis ◽  
Obese Patients ◽  
Sternal Closure

scholarly journals 175 Sternal Closure with Single Compared to Double or Figure-Of-8 Wires in Obese Patients Post Cardiac Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Ahmed Mohamed Abdel Shafi ◽  
Eyad Abuelgasim ◽  
Biyaser Abuelgasim ◽  
Sashini Iddawela ◽  
Amer Harky
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Meta Analysis ◽  
Median Sternotomy ◽  
High Risk Group ◽  
Published Data ◽  
Obese Patients ◽  
Closure Technique ◽  
Single Wire ◽  
Sternal Closure

Abstract Aim Sternal instability and wound infections are a major cause of morbidity following cardiac surgery, which is further amplified in high-risk patients that include diabetics and patients with high BMI. We compare the different outcomes of different sternal wire closure techniques following median sternotomy for cardiac surgery in obese patients Method A comprehensive electronic literature search was undertaken according to PRISMA guidelines from inception to July 2020 to identify all published data comparing single wire sternal closure to either double wire or figure-of-8 techniques following median sternotomy for cardiac surgery in obese patients, defined as a BMI ≥ 30. Results Eight studies met the final inclusion criteria; single wire versus double wire sternal closure (n = 2) and single wire versus figure-of-8 wire closure (n = 6). Higher rate of sternal instability was noted in single wire vs double wire closure (22/150 (14.7%) patients vs 6/150 (4%) patients, p = 0.003, OR 0.25 [95% CI 0.10-0.63]). Similarly, sternal instability was higher in single wire vs figure-of-8 wire closure technique (33/2422 (1.3%) vs 11/8035 (0.1%), p = 0.04 OR 0.30 [95% CI, 0.09-0.96]) respectively. Conclusions There is benefit in the use of either double or figure-of-8 sternal wire closure techniques over single wire closure in terms of sternal instability. However, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing the optimal sternal closure technique in this high-risk group of patients.

scholarly journals Correction: Hill, A.; et al. Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis. Nutrients 2019, 11, 2103

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3910
Author(s):  
Aileen Hill ◽  
Kai Clasen ◽  
Sebastian Wendt ◽  
Ádám Majoros ◽  
Christian Stoppe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Vitamin C ◽  
Meta Analysis ◽  
Organ Function

The authors thank the readers for pointing out the issues [...]

scholarly journals Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Review of Randomized Controlled Trials and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 479
Author(s):  
Tatiana Sidiropoulou ◽  
Kalliopi Christodoulaki ◽  
Charalampos Siristatidis
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Randomized Controlled Trials ◽  
Success Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Technical Failure ◽  
Obese Patients ◽  
Randomized Controlled ◽  
Meta Analyses

A pre-procedural ultrasound of the lumbar spine is frequently used to facilitate neuraxial procedures. The aim of this review is to examine the evidence sustaining the utilization of pre-procedural neuraxial ultrasound compared to conventional methods. We perform a systematic review of randomized controlled trials with meta-analyses. We search the electronic databases Medline, Cochrane Central, Science Direct and Scopus up to 1 June 2019. We include trials comparing a pre-procedural lumbar spine ultrasound to a non-ultrasound-assisted method. The primary endpoints are technical failure rate, first-attempt success rate, number of needle redirections and procedure time. We retrieve 32 trials (3439 patients) comparing pre-procedural lumbar ultrasounds to palpations for neuraxial procedures in various clinical settings. Pre-procedural ultrasounds decrease the overall risk of technical failure (Risk Ratio (RR) 0.69 (99% CI, 0.43 to 1.10), p = 0.04) but not in obese and difficult spinal patients (RR 0.53, p = 0.06) and increase the first-attempt success rate (RR 1.5 (99% CI, 1.22 to 1.86), p < 0.0001, NNT = 5). In difficult spines and obese patients, the RR is 1.84 (99% CI, 1.44 to 2.3; p < 0.0001, NNT = 3). The number of needle redirections is lower with pre-procedural ultrasounds (SMD = −0.55 (99% CI, −0.81 to −0.29), p < 0.0001), as is the case in difficult spines and obese patients (SMD = −0.85 (99% CI, −1.08 to −0.61), p < 0.0001). No differences are observed in procedural times. Ιn conclusion, a pre-procedural ultrasound provides significant benefit in terms of technical failure, number of needle redirections and first attempt-success rate. Τhe effect of pre-procedural ultrasound scanning of the lumbar spine is more significant in a subgroup analysis of difficult spines and obese patients.

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