scholarly journals Effect of the Type of Intraoperative Restrictive Fluid Management on the Outcome of Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Jian Wang ◽  
Wenchong Sun ◽  
Zhongbao Fan ◽  
Xin An ◽  
Ling Pei
Keyword(s):  
Systematic Review ◽  
Perioperative Management ◽  
Retrospective Studies ◽  
Meta Analysis ◽  
Fluid Management ◽  
Length Of Hospital Stay ◽  
Cochrane Library ◽  
Pancreatic Fistulas ◽  
Prospective Trials ◽  
Intraoperative Fluids

Background. The perioperative management of pancreaticoduodenectomy is complicated, and the significant morbidity and mortality may be influenced by the method of intraoperative fluid management. Whether intraoperative restrictive fluid therapy can affect the outcomes of pancreaticoduodenectomy or not is controversial. Methods. PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov were searched for prospective and retrospective studies comparing restrictive and liberal intraoperative fluids in patients undergoing pancreaticoduodenectomy. Following study identification, a systematic review and meta-analysis were performed. Results. Fourteen studies, including six prospective trials and eight retrospective studies, involving 2,596 patients, were included. Intraoperative restrictive fluid regimens had no effect on the mortality compared to liberal fluid regimens in the overall cohort (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 0.82–2.35, p = 0.773 ). Liberal fluid regimens could increase the risk of pulmonary adverse events (OR: 1.66; 95% CI: 1.10–2.50, p = 0.131 ) and prolong the length of hospital stay (SMD -0.10; 95% CI -0.19– -0.01, p = 0.375 ). There were no significant differences in the incidence of pancreatic fistulas. Conclusions. Restrictive fluid regimens have a slight effect on the outcomes of pancreaticoduodenectomy. The clinical relevance of this finding needs to be interpreted. The existing evidence may not be adequate; therefore, further studies are warranted.

Impact of trainee involvement in esophagectomy on clinical outcomes: a narrative systematic review of the literature

2019 ◽  
Vol 32 (10) ◽  
pp. 1-8
Author(s):  
P Prasad ◽  
M Navidi ◽  
A Immanuel ◽  
S M Griffin OBE ◽  
A W Phillips
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Cochrane Library ◽  
Published Data ◽  
Meta Analyses ◽  
The Impact

SUMMARY Changes in the structure of surgical training have affected trainees’ operative experience. Performing an esophagectomy is being increasingly viewed as a complex technical skill attained after completion of the routine training pathway. This systematic review aimed to identify all studies analyzing the impact of trainee involvement in esophagectomy on clinical outcomes. A search of the major reference databases (Cochrane Library, MEDLINE, EMBASE) was performed with no time limits up to the date of the search (November 2017). Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Four studies that included a total of 42 trainees and 16 consultants were identified, which assessed trainee involvement in open esophagogastric resectional surgery. A total of 1109 patients underwent upper gastrointestinal procedures, of whom 904 patients underwent an esophagectomy. Preoperative characteristics, histology, neoadjuvant treatment, and overall length of hospital stay were comparable between groups. One study found higher rates of anastomotic leaks in procedures primarily performed by trainees as compared to consultants (P < 0.01)—this did not affect overall morbidity or survival; however, overall anastomotic leak rates from the published data were 10.4% (trainee) versus 6.3% (trainer) (P = 0.10). A meta-analysis could not be performed due to the heterogeneity of data. The median MINORS score for the included studies was 13 (range 11–15). This study demonstrates that training can be achieved with excellent results in high-volume centers. This has important implications on the consent process and training delivered, as patients wish to be aware of the risks involved with surgery and can be reassured that appropriately supervised trainee involvement will not adversely affect outcomes.

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.

scholarly journals Effect of Restrictive Versus Liberal Fluid Management Strategies on Major Adverse Kidney Events in Critically Ill Adult Patients: A Protocol for a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Melissa Herdzik ◽  
Amanda Y. Leong ◽  
Sandy Kassir ◽  
Eric Sy ◽  
Jonathan F. Mailman
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Meta Analysis ◽  
Fluid Management ◽  
Management Strategies ◽  
Current Evidence ◽  
Cochrane Library ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Major Adverse Kidney Events

Abstract BackgroundIntravenous fluid therapy is ubiquitous in intensive care units (ICUs). There is increasing recognition of the value of restrictive fluid management strategies, including improved survival and renal function. However, these strategies have not been universally adopted. The purpose of this protocol is to outline our plan for investigating the current literature on the topic of restrictive versus liberal fluid management strategies in all critically ill adults and their associated outcomes, namely major adverse kidney events (MAKE). Methods We will conduct a systematic review and meta-analysis of randomized controlled trials evaluating fluid management strategies in critically ill adults. A search strategy was created with the help of medical librarians, using Ovid MEDLINE, PubMed, EMBASE, CINAHL, Web of Science, and The Cochrane Library. Four independent researchers will perform study selection and data extraction in duplicate. The primary outcome of this study is detection of MAKE by 30 days. Secondary outcomes include reporting MAKE at 60 and 90 days; and mortality, new onset renal replacement therapy, and persistent renal dysfunction at 30, 60, and 90 days. If appropriate, we will perform a meta-analysis using a DerSimonian and Laird random-effects model. Subgroups will include patient type, ICU type, and study quality. Certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach.DiscussionThe results of this study will synthesize current evidence and better inform the optimal fluid management strategy in critically ill adults.Systematic review registration: Submitted to PROSPERO on June 16th, 2021.

scholarly journals Antiphospholipid Antibody and Recurrent Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3728-3732
Author(s):  
Yerim Kim ◽  
Soo Young Kim
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Young Patients ◽  
Cochrane Library ◽  
Computer Assisted ◽  
Antiphospholipid Antibody ◽  
Prospective Trials ◽  
Meta Analyses ◽  
Review Manager

Background and Purpose: Although aPLs (antiphospholipid antibodies) are associated with thrombotic events, especially in young patients, the role of aPLs in recurrent ischemic strokes (RIS) is unclear. This systematic review and meta-analysis evaluated the association between aPLs and RIS. Methods: The systematic review was conducted by a computer-assisted search of literature in PubMed, EMBASE, and Cochrane library published in English or Korean from 1990, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Review Manager 5.3 software was used for statistical analyses. Results: Of the 2272 identified articles, 8 studies were included (2510 subjects; 844 aPL positive). The meta-analysis revealed a relative risk of aPLs for RIS of 1.41 (95% CI, 0.91–2.17; I 2 =54%). In the subgroup analysis, age <50 years, ethnicity, and type of aPL did not increase the risk of RIS. Conclusions: We found that aPLs are not an independent predictor for RIS in adults. However, considering the nonstandardized disease criteria, further well-designed prospective trials should be considered to confirm these findings.

scholarly journals Corticosteroids for Treating Sepsis in Adult Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Huoyan Liang ◽  
Heng Song ◽  
Ruiqing Zhai ◽  
Gaofei Song ◽  
Hongyi Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Evaluation Methodology ◽  
Cochrane Library ◽  
Assessment Development ◽  
Short Time ◽  
Long Term Mortality

ObjectiveCorticosteroids are a common option used in sepsis treatment. However, the efficacy and potential risk of corticosteroids in septic patients have not been well assessed. This review was performed to assess the efficacy and safety of corticosteroids in patients with sepsis.MethodsPubMed, Embase, and Cochrane library databases were searched from inception to March 2021. Randomized controlled trials (RCTs) that evaluated the effect of corticosteroids on patients with sepsis were included. The quality of outcomes in the included articles was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation methodology. The data were pooled by using risk ratio (RR) and mean difference (MD). The random-effects model was used to evaluate the pooled MD or RR and 95% confidence intervals (CIs).ResultsFifty RCTs that included 12,304 patients with sepsis were identified. Corticosteroids were not associated with the mortality in 28-day (RR, 0.94; 95% CI, 0.87–1.02; evidence rank, moderate) and long-term mortality (&gt;60 days) (RR, 0.96; 95% CI, 0.88–1.05) in patients with sepsis (evidence rank, low). However, corticosteroids may exert a significant effect on the mortality in the intensive care unit (ICU) (RR, 0.9; 95% CI, 0.83–0.97), in-hospital (RR, 0.9; 95% CI, 0.82–0.99; evidence rank, moderate) in patients with sepsis or septic shock (evidence rank, low). Furthermore, corticosteroids probably achieved a tiny reduction in the length of hospital stay and ICU. Corticosteroids were associated with a higher risk of hypernatremia and hyperglycemia; furthermore, they appear to have no significant effect on superinfection and gastroduodenal bleeding.ConclusionsCorticosteroids had no significant effect on the 28-day and long-term mortality; however, they decreased the ICU and hospital mortality. The findings suggest that the clinical corticosteroids may be an effective therapy for patients with sepsis during the short time.Systematic Review Registrationhttps://inplasy.com/wp-content/uploads/2021/05/INPLASY-Protocol-1074-4.pdf

scholarly journals LigaSure small jaw versus conventional neck dissection: a systematic review and meta-analysis

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Tai-Yu Chen ◽  
Li-Jen Hsin ◽  
Wan-Ni Lin ◽  
Ming-Shao Tsai ◽  
Yao-Te Tsai ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neck Dissection ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Pooled Analysis ◽  
Cochrane Library ◽  
Postoperative Hematoma ◽  
Personal Experiences ◽  
The Cochrane Library

Abstract Background Neck dissection has a central role in the management of head and neck cancers. This systematic review aimed to compare the intraoperative and postoperative parameters between conventional and LigaSure Small Jaw (LSJ)-assisted neck dissection. Methods PubMed (MEDLINE), Embase, and the Cochrane Library were searched. independently by two authors for relevant articles comparing the outcomes of conventional and LSJ-assisted neck dissection. Data from each study were extracted, and a random-effects model was used in the pooled analysis. Results Compared with conventional techniques, LSJ-assisted neck dissection was associated with a significantly reduced operative time. The rates of postoperative hematoma, infection, amount of intraoperative blood loss, the length of hospital stay and the drainage amount showed no significant intergroup differences. Conclusions The meta-analysis provides evidence that properly using LSJ may reduce the operative time compared with that of conventional techniques. Surgeons may consider using LSJ in neck dissection according to personal experiences. Graphical abstract

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 Can tranexamic acid reduce the blood transfusion rate in patients undergoing percutaneous nephrolithotomy? A systematic review and meta-analysis

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091756
Author(s):  
Zhenghao Wang ◽  
Xiao He ◽  
Yunjin Bai ◽  
Jia Wang
Keyword(s):  
Systematic Review ◽  
Blood Transfusion ◽  
Tranexamic Acid ◽  
Percutaneous Nephrolithotomy ◽  
Selection Process ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Cochrane Library ◽  
Transfusion Rate ◽  
Substantial Impact

Objective A systematic review and meta-analysis was conducted to explore the efficacy of tranexamic acid (TXA) in reducing transfusion events in patients undergoing percutaneous nephrolithotomy (PCNL). Methods PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases from January 1980 to October 2019 were searched for randomized controlled trials (RCTs) that assessed TXA efficacy in reducing transfusion events during PCNL. Intervention treatments include using TXA compared with placebo (or no intervention) for patients who underwent PCNL. The search strategy and study selection process were managed in accordance with the PRISMA statement. Results Six RCTs are included in the meta-analysis. Overall, TXA intervention groups showed a significant reduction in blood transfusion events (RR = 0.34; 95% confidence interval [CI] = 0.19 to 0.62), hemoglobin decrease (MD = −0.80; 95% CI = −1.32 to −0.28), operative time (MD = −12.62; 95% CI = −15.62 to −9.61), and length of hospital stay (MD = −0.73; 95% CI = −1.36 to −0.10) compared with control groups after PCNL. However, TXA had no substantial impact on the rate of stone clearance (RR = 1.10; 95% CI = 1.00 to 1.21). Conclusions TXA can effectively reduce the transfusion rate and blood loss during PCNL.

Effect of dexmedetomidine on lung function and prognosis a systematic review and meta-analysis

2020 ◽  
Author(s):  
Bingcheng Chen ◽  
Jing Yang ◽  
Guoliang Sun ◽  
Weifeng Yao ◽  
Ziqing Hei
Keyword(s):  
Systematic Review ◽  
Lung Function ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Cochrane Library ◽  
Extubation Time ◽  
Significant Difference ◽  
Respiratory Index

Abstract Background: This systematic review and meta-analysis aimed to evaluate the effect of dexmedetomidine on lung function and prognosis.Methods: We searched PubMed, Embase and the Cochrane Library from inception to January 30, 2020 following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement guidelines. Randomized controlled trials of dexmedetomidine associated with lung function were assessed. The primary outcomes are pH, PaO2, PaCO2, respiratory index (RI) and time to extubation. The secondary outcomes are PaO2/FiO2, length of hospital stay and events of pulmonary complications.Results: 17 trials of 924 patients were included. Compared with placebo group, dexmedetomidine group had higher PaO2 (MD: 10.96; 95% CI: from 0.77 to 21.15; p=0.04) and PaO2/FiO2 (MD: 30.77; 95% CI: from 19.11 to 42.43; p<0.00001). The dexmedetomidine group had lower PaCO2 (MD: -0.88; 95% CI: from -1.66 to -0.11; p=0.002) and shorter length of hospital stay (MD: -1.19; 95% CI: from -2.21 to -0.16; p=0.02). The dexmedetomidine group had lower occurrence of pulmonary complications (RR: 0.28; 95% CI: from 0.09 to 0.82; p=0.02). However, there is no significant difference in pH, respiratory index and extubation time.Conclusion: Dexmedetomidine has better influence on lung function and prognosis.

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