A Systematic Review of Definitive Treatment for Inverted Papilloma Attachment Site and Associations With Recurrence

Objective Inverted papilloma (IP) is the most common benign neoplasm of the nasal cavity with known risk of recurrence. There is no standardized approach to definitive treatment for attachment sites. This systematic review aims to determine whether surgeon choice of technique differs by anatomic attachment site and whether different surgical techniques contribute to reduced rates of recurrence. Data Sources PubMed and Ovid Medline. Review Methods A systematic review was conducted for studies reporting on IP. Those that included IP recurrence rates and primary tumor attachment site were reviewed. Results Of 122 published studies, 14 met eligibility criteria, representing 585 patients and a recurrence rate of 5.8%. The maxillary sinus (50.9%) was the most common primary attachment site, and the sphenoid sinus was associated with the highest rate of recurrence (10.4%). The most utilized technique included debulking the tumor, removing mucosa over the attachment site, and drilling the underlying bone. The most common Krouse stage represented was T3 (53.3%). No single technique predicted a propensity for recurrence, but certain techniques are favored depending on IP attachment site. Finally, frozen sections to obtain evidence of clear margins intraoperatively significantly reduced rates of recurrence (3.4% vs 7.3%, P = .045). Conclusion Based on the current literature, the most common technique to address site of attachment involves resecting mucosa and drilling the tumor base. Choice of technique appears to differ for various sites of attachment. Use of intraoperative frozen section analysis appears to be associated with decreased recurrence overall. Level of Evidence 3.

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Frozen section analysis for organ-conserving surgery in penile cancer: Assessing oncological outcomes and trends of local recurrence

Journal of Clinical Urology ◽

10.1177/2051415820903192 ◽

2020 ◽

Vol 13 (6) ◽

pp. 419-424

Author(s):

T Ellul ◽

P Grice ◽

A Mainwaring ◽

N Bullock ◽

A Shanahan ◽

...

Keyword(s):

Local Recurrence ◽

Penile Cancer ◽

Frozen Section ◽

Surgical Margin ◽

Positive Margin ◽

Surgical Excision ◽

Recurrence Rates ◽

Level Of Evidence ◽

Positive Margins ◽

Positive Margin Rate

Introduction and objectives: The local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and 29%. Intra-operative frozen section (FS) is a useful tool to ensure safe microscopic margins in organ-sparing procedures in penile cancer. In this series, we assessed the rates of positive margins and patterns of local recurrence in a multicentre cohort of patients undergoing penile-preserving surgery assisted by intra-operative FS analysis. Materials and methods: We reviewed all those patients for whom intra-operative FS was employed during penile-preserving surgery in three tertiary referral centres between 2003 and 2016. We assessed whether the use of FS altered the surgical technique and what affect it had on positive margins and recurrence rates. Results: A total of 169 patients were identified. Of these, intra-operative FS examination of the surgical margin was positive in 21 (12%) cases. Final histological examination confirmed cancer-free margins in all but one patient (99.4%). Overall, 9 patients developed local recurrence (5.3%). Conclusions: In this series, intra-operative FS contributed to a very low rate (5.3%) of local recurrence. We noted an extremely low positive margin rate (0.6%) which highlights the benefit of incorporating FS analysis into organ-preserving surgery for penile cancer. Level of evidence: Not applicable for this multicentre audit.

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Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes

Cartilage ◽

10.1177/1947603519870858 ◽

2019 ◽

pp. 194760351987085 ◽

Cited By ~ 2

Author(s):

Anthony Fiegen ◽

Devin P. Leland ◽

Christopher D. Bernard ◽

Aaron J. Krych ◽

Jonathan D. Barlow ◽

...

Keyword(s):

Systematic Review ◽

Patient Reported Outcomes ◽

Glenohumeral Joint ◽

Meta Analysis ◽

Treatment Options ◽

Surgical Techniques ◽

Cartilage Defects ◽

Imaging Findings ◽

Level Of Evidence ◽

Patient Reported

Objective To report radiographic and magnetic resonance imaging findings, patient-reported outcomes, and complications and/or reoperations following nonarthroplasty surgical intervention for focal glenohumeral cartilage defects. Design A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Patients were included if they possessed a chondral defect of the humeral head, glenoid, or both, which had been treated with a joint preserving nonarthroplasty procedure. Risk of bias assessment was performed using the Methodological Index for Non-Randomized Studies scoring system. Study demographics, surgical technique, imaging findings, patient-reported outcomes, complications, failures, and reoperations were collected. Results Fourteen studies with 98 patients (100 shoulders) met the inclusion criteria. Patient ages ranged from 7 to 74 years. The nonarthroplasty surgical techniques utilized included microfracture (67 shoulders), osteochondral transplantation (28 shoulders), chondrocyte transplantation (4 shoulders), and internal fixation (1 shoulder). The rates of radiographic union and progression of osteoarthritis ranged between 90% to 100% and 57% to 100%, respectively. Visual analog scores ranged from 0 to 1.9 at final follow-up. Mean postoperative ASES (American Shoulder and Elbow Surgeons) shoulder scores ranged from 75.8-100. Mean postoperative CSS (Constant Shoulder Score) scores ranged from 83.3-94. Mean postoperative SSV (Subjective Shoulder Value) ranged from 70% to 99%. Failure and reoperation rates ranged between 0% to 35% and 0% to 30%, respectively, with the most common reoperation being conversion to prosthetic arthroplasty. Conclusions In this systematic review, nonarthroplasty surgical techniques demonstrated acceptable rates of radiographic healing, improved patient reported outcomes, minimal complications, and low rates of failure or reoperation. Joint preserving techniques are likely viable options to prolong function of the native shoulder and provide short- to midterm pain relief in young and highly active patients. Level of Evidence Level IV.

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A SYSTEMATIC REVIEW OF COMPLICATIONS AND RECURRENCE RATE OF ARTHROSCOPIC RESECTION OF VOLAR WRIST GANGLION

Hand Surgery ◽

10.1142/s0218810414300046 ◽

2014 ◽

Vol 19 (03) ◽

pp. 475-480 ◽

Cited By ~ 11

Author(s):

Carlos Henrique Fernandes ◽

Cesar Dario Oliveira Miranda ◽

João Baptista Gomes dos Santos ◽

Flavio Faloppa

Keyword(s):

Systematic Review ◽

Recurrence Rate ◽

Operative Procedure ◽

Arthroscopic Surgery ◽

Surgical Techniques ◽

Inclusion Criteria ◽

Recurrence Rates ◽

Level I ◽

English Articles ◽

Midcarpal Joint

The purpose of this systematic review is to determine the incidence of complications and the recurrence rate of a volar wrist ganglion following arthroscopic resection. We performed a systematic review of English and non-English articles using Google Scholar, Medline, and Web of Knowledge. Articles were screened for study inclusion by three independent reviewers using the terms "arthroscopic treatment of volar wrist ganglion" and "arthroscopic resection of volar wrist ganglion". Inclusion criteria: (1) level I–V evidence, (2) documentation of the number of wrists subjected to surgery, (3) documentation of surgical techniques used on wrists, and (4) documentation of surgical or post-surgical complications and recurrence rate of a volar wrist ganglion after arthroscopic resection. A complication was defined as an adverse outcome that was directly related to the operative procedure. Between 2001 and 2012, 13 articles met the inclusion criteria. Two articles were excluded and 11 were reviewed. A total of 232 wrists underwent arthroscopic surgery with 14 recurrences. The recurrence rate ranged from 0 to 20%, with mean of 6.03%. There were 16 (6.89%) complications. There was no connection with the ganglion in six wrists, three haematomas, three cases of neuropraxia of the dorsal radial nerve, two partial lesions of the median nerve, and two lesions of a branch of the radial artery. Patients did not have a decrease in the arc range of motion. Treatment of volar ganglia of the midcarpal joint was technically difficult and associated with a higher number of complications. In general, arthroscopic resection results in fewer complications and lower recurrence rates than an open surgical approach, but there is no clear evidence of such an advantage for arthroscopic resection of a volar wrist ganglion. Additional prospective, controlled clinical trials will be essential to address this important issue.

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Use of Intraoperative Negative Margins Reduces Inverted Papilloma Recurrence

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2018.32.4504 ◽

2018 ◽

Vol 32 (1) ◽

pp. 57-60 ◽

Cited By ~ 4

Author(s):

Amar Miglani ◽

Joseph M. Hoxworth ◽

Matthew A. Zarka ◽

Devyani Lal

Keyword(s):

Frozen Section ◽

Standard Of Care ◽

Inverted Papilloma ◽

Inclusion Criteria ◽

Recurrence Rates ◽

Predictive Values ◽

Endoscopic Techniques ◽

Time Of Presentation ◽

Very High

Background Recurrence of inverted papilloma (IP) is a problem in 12–17% of tumors. Controversy exists regarding benefits of intraoperative frozen section histopathology (IFSH) for IP resection; however, to our knowledge, no study has specifically investigated this. IFSH for IP resection is the standard of care in our practice. We, therefore, reviewed our outcomes of using IFSH for IP resection. A secondary goal was to assess the reliability of IFSH. Methods Patients with IP who underwent surgical resection (2010–2016) with minimum 9–month follow-up were included. Results Twenty-two adults with IP met inclusion criteria. All underwent surgery via endoscopic techniques, supplemented by external ports in five patients. At the time of presentation, 36% IPs were recurrent tumors; 68% were graded as Krouse stage 3. Resection was conducted until “clear” (negative) mucosal margins were achieved on IFSH. In 6 (27%), a “positive” IFSH result dictated additional resection to clear margins. Final negative margins were achieved in all the patients. Both positive and negative predictive values for IFSH were 100% (concordance with final pathology results). Surveillance was performed every 1–6 months with nasal endoscopy by using imaging when necessary. No recurrences were noted (0%) at mean follow-up of 40 months (range, 10 -73 months). Conclusions Positive IFSH results led to increased resection in 27% of the patients, with a 0% recurrence rate in this cohort. The reliability of IFSH for IP is very high. No recurrence of IP was noted in any patient at a mean follow-up of 3.3 years. IFSH may help reduce recurrence rates of IP, but additional studies with longer follow-up are warranted.

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Opioid Use After Common Sports Medicine Procedures: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120913293 ◽

2020 ◽

Vol 12 (3) ◽

pp. 225-233 ◽

Cited By ~ 1

Author(s):

Ujash Sheth ◽

Mitesh Mehta ◽

Fernando Huyke ◽

Michael A. Terry ◽

Vehniah K. Tjong

Keyword(s):

Systematic Review ◽

Sports Medicine ◽

Management Strategies ◽

Opioid Consumption ◽

Opioid Use ◽

Prescribing Practices ◽

Eligibility Criteria ◽

Level Of Evidence ◽

Opioid Prescribing ◽

Arthroscopic Procedures

Context: The prescription of opioids after elective surgical procedures has been a contributing factor to the current opioid epidemic in North America. Objective: To examine the opioid prescribing practices and rates of opioid consumption among patients undergoing common sports medicine procedures. Data Sources: A systematic review of the electronic databases EMBASE, MEDLINE, and PubMed was performed from database inception to December 2018. Study Selection: Two investigators independently identified all studies reporting on postoperative opioid prescribing practices and consumption after arthroscopic shoulder, knee, or hip surgery. A total of 119 studies were reviewed, with 8 meeting eligibility criteria. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: The quantity of opioids prescribed and used were converted to milligram morphine equivalents (MMEs) for standardized reporting. The quality of each eligible study was evaluated using the Methodological Index for Non-Randomized Studies. Results: A total of 8 studies including 816 patients with a mean age of 43.8 years were eligible for inclusion. A mean of 610, 197, and 613 MMEs were prescribed to patients after arthroscopic procedures of the shoulder, knee, and hip, respectively. At final follow-up, 31%, 34%, and 64% of the prescribed opioids provided after shoulder, knee, and hip arthroscopy, respectively, still remained. The majority of patients (64%) were unaware of the appropriate disposal methods for surplus medication. Patients undergoing arthroscopic rotator cuff repair had the highest opioid consumption (471 MMEs), with 1 in 4 patients receiving a refill. Conclusion: Opioids are being overprescribed for arthroscopic procedures of the shoulder, knee, and hip, with more than one-third of prescribed opioids remaining postoperatively. The majority of patients are unaware of the appropriate disposal techniques for surplus opioids. Appropriate risk stratification tools and evidence-based recommendations regarding pain management strategies after arthroscopic procedures are needed to help curb the growing opioid crisis.

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Sex-Based Differences in the Incidence of Sports-Related Concussion: Systematic Review and Meta-analysis

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119877186 ◽

2019 ◽

Vol 11 (6) ◽

pp. 486-491 ◽

Cited By ~ 5

Author(s):

Jennifer Cheng ◽

Brittany Ammerman ◽

Kristen Santiago ◽

Bridget Jivanelli ◽

Emerald Lin ◽

...

Keyword(s):

Systematic Review ◽

Study Design ◽

Rate Ratio ◽

Meta Analysis ◽

Incidence Rates ◽

Ice Hockey ◽

Cochrane Library ◽

Eligibility Criteria ◽

Level Of Evidence ◽

Meta Regression

Context: The incidence of sports-related concussion in females has been increasing in recent years. Objective: To conduct a meta-analysis on sex-based differences in concussion incidence in various sports and to determine the effects of study design (retrospective vs prospective), setting (competition vs practice), and population (university and above vs high school and below) via a meta-regression. Data Sources: PubMed (Medline), EMBASE, and Cochrane Library databases were searched from January 2000 to January 2018. Study Selection: Studies reporting sports-related concussion incidence data for both males and females (age ≥10 years) were included. Study Design: Systematic review with meta-analysis and meta-regression. Level of Evidence: Level 4. Methods: The rate ratio was calculated as the concussion rate in females/males. Data were pooled using the DerSimonian-Laird random-effects model. Results: Thirty-eight studies met the eligibility criteria and were included in the meta-analysis. Soccer and basketball demonstrated significantly higher incidence of concussions in females compared with males (rate ratio [95% CI], 1.76 [1.43-2.16] and 1.99 [1.56-2.54], respectively; P < 0.01). Sex-based differences in concussion incidence rates for baseball/softball, ice hockey, lacrosse, swimming/diving, and track and field were not statistically significant. In the meta-regression analysis, there were no significant effects on the rate ratio when evaluating study design, setting, and population. Conclusion: Concussion incidence rates were significantly higher in females than in males for soccer and basketball.

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The use of antibiotic prophylaxis in hip arthroscopy is under-reported and lacks evidence-based guidelines: a systematic review and survey

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2017-000157 ◽

2017 ◽

Vol 3 (2) ◽

pp. 105-109

Author(s):

Seper Ekhtiari ◽

Chloe E Haldane ◽

Darren de SA ◽

Nicole Simunovic ◽

Ivan H Wong ◽

...

Keyword(s):

Systematic Review ◽

Antibiotic Prophylaxis ◽

Hip Arthroscopy ◽

Postoperative Infection ◽

Practice Patterns ◽

Surgical Techniques ◽

High Volume ◽

Prophylactic Antibiotics ◽

Infection Rates ◽

Level Of Evidence

ImportanceHip arthroscopy is an increasingly common orthopaedic procedure with postoperative infection rates<5%. With the growing challenge of antibiotic resistance and rising healthcare costs, it is important to establish whether antibiotic prophylaxis is routinely used in hip arthroscopy, and whether it is necessary.ObjectiveThe objectives of this review were to (1) report current practice patterns with regard to antibiotic prophylaxis for hip arthroscopy and (2) present the available evidence regarding the use of antibiotic prophylaxis in hip arthroscopy.Evidence reviewThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the execution and reporting of this study. The databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate. Data regarding patient demographics, surgical indications, surgical techniques, use of antibiotic prophylaxis and adverse events were collected. Study quality was assessed in duplicate using Methodological Index for Non-Randomised Studies criteria. A survey was distributed to high-volume hip arthroscopists to gauge their practice patterns. Data were analysed and presented using descriptive statistics.FindingsNine studies of primarily level IV evidence (78%) and of fair quality were included. Overall, 592 patients (652 hips; 56.2% male) were included in the review, with a mean age of 40.6 years. Notably, 1069 otherwise eligible studies were excluded from this review because they did not report on their use (or lack thereof) of prophylactic antibiotics. Overall, 390 patients received routine antibiotic prophylaxis, 160 patients did not and 42 patients received prophylaxis only if an implant was used. Only three infections were reported among 652 operations, with all infections from studies that routinely used antibiotic prophylaxis. The survey had a 60% response rate (21/35), and revealed that 81% of respondents routinely provide prophylactic antibiotics, most commonly preoperative intravenous cefazolin (66.7%). The most common postoperative antibiotic was cephalexin.Conclusions and relevanceAntibiotic prophlyaxis use in hip arthroscopy is very under-reported. Routine prophylaxis was the most common practice pattern in both the literature and the survey. Overall, postoperative infection rates are extremely low. Future studies are required to prospectively assess the role of antibiotic prophylaxis in hip arthroscopy.Level of evidenceLevel IV, systematic review of level III and IV studies

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Historical analysis of the diagnosis and management of femoroacetabular impingement prior to the year 2000: a systematic review

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa055 ◽

2020 ◽

Author(s):

Tushar Tejpal ◽

Ajaykumar Shanmugaraj ◽

Jeffery Kay ◽

Nicole Simunovic ◽

Olufemi R Ayeni

Keyword(s):

Systematic Review ◽

Femoroacetabular Impingement ◽

Complication Rate ◽

Groin Pain ◽

Periacetabular Osteotomy ◽

Surgical Techniques ◽

Historical Analysis ◽

Level Of Evidence ◽

Surgical Dislocation ◽

Year 2000

Abstract This systematic review aims to assess the diagnosis, indications and treatment of femoroacetabular impingement (FAI) prior to the year 2000 and to determine if historical concepts remain applicable today. PUBMED, MEDLINE and EMBASE were searched for literature evaluating the diagnosis/treatment of FAI prior to 2000. Cadaver/non-human, non-English and review studies were excluded. Quality assessment was performed using the Methodological Index for Non-Randomized Studies. Nine studies comprising 307 patients [315 hips; mean age of 32.6 ± 2.4 years (range, 12–58)] were included. Patients reported groin pain. Magnetic resonance arthrography (MRA; n = 76) and the anterior impingement test (AIT) (n = 88) were used to diagnose impingement. Surgical dislocation with a trochanteric flip osteotomy (n = 237) and Bernese periacetabular osteotomy (n = 40) were common treatments. Pain and range of motion improved for patients. Overall complication rate was 35% (n = 99), with heterotopic ossification (n = 79) most commonly reported. Prior to 2000, there was low quantity and quality of research on the diagnosis/management of FAI. Diagnostic evaluation was primarily through clinical examination (i.e. groin pain and AIT). MRA was occasionally used to detect labral degeneration; however, utilization of computed tomography (CT) and diagnostic injections were not reported. Surgical dislocation and osteotomies of the acetabulum yielded desirable short-term clinical outcomes with a moderate complication rate. No study reported using arthroscopy for FAI management prior to 2000. Clinicians today can learn from historical principles (i.e. clinical diagnosis of FAI, management with surgical correction of femoral head–neck offset) while applying novel techniques (i.e. CT, injections, arthroscopic surgical techniques and rehabilitation) to improve patient outcomes. Level of Evidence: IV (systematic review of III and IV evidence).

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Oral status of older people in medium to long-stay health and social care setting: a systematic review

BMC Geriatrics ◽

10.1186/s12877-021-02302-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Juan Antonio Ruiz-Roca ◽

Dora Martín Fuentes ◽

Francisco J. Gómez García ◽

Yolanda Martínez-Beneyto

Keyword(s):

Systematic Review ◽

Health Status ◽

Oral Health ◽

Older People ◽

Soft Tissues ◽

Oral Health Status ◽

Cochrane Library ◽

Eligibility Criteria ◽

Level Of Evidence ◽

Health And Social Care

Abstract Background Older patients who spend long periods hospitalized or those who are in a situation of institutionalization represent a risk group in this regard, as many of them suffer a degree of dependence and need help to perform the basic tasks of personal care. It is therefore important to learn more of the oral health status of this group of patients in order to make a proper assessment of the situation and to develop protocols for its management. The purpose of the study was to conduct a systematic review to ascertain the oral health status of older people patients admitted to institutions or hospitalized for a long period of time. Methods a systematic review of the literature published in two different databases (PubMed, Embase and Cochrane Library) was carried out, with 12 different combinations of keywords based on the following selection criteria: studies published in the last 5 years, in English and/or Spanish and/or Portuguese, with samples of ≥30 patients, performed in patients older than 65 years, admitted to any type of institution and/or hospital center for at least 7 days and in which the state of hard and/or soft tissues of the oral cavity were evaluated in some way. The selected articles were subjected to a thorough analysis. Results The search strategy covered 1.014 articles: 689 from Pubmed and 325 from Cochrane Library. After applying the eligibility criteria, five articles were selected for our review. The level of evidence of the articles was, a sample of 773 patients most of them were women with an average age older than 70 years old. Conclusions The oral health of patients aged more than 65 is worse than that of the rest population. Long hospital stays or being institutionalized in a residence makes this group susceptible to a worsening of their oral health status. It is necessary to develop protocols for the oral health care of these patients, accompanied by training programs for the personnel responsible.

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Oral Status of Elderly Patients In Long Stay Centers: A Systematic Review

10.21203/rs.3.rs-120464/v1 ◽

2020 ◽

Author(s):

Juan Antonio Ruiz Roca ◽

Dora Martín Fuentes ◽

Yolanda Martínez Beneyto ◽

Ricardo E. Oñate Sanchez

Keyword(s):

Systematic Review ◽

Health Status ◽

Oral Health ◽

Elderly Patients ◽

Soft Tissues ◽

Oral Health Status ◽

Cochrane Library ◽

Eligibility Criteria ◽

Level Of Evidence ◽

Hospital Stays

Abstract Background Elderly patients who spend long periods hospitalized or those who are in a situation of institutionalization represent a risk group in this regard, as many of them suffer a degree of dependence and need help to perform the basic tasks of personal care. It is therefore important to learn more of the oral health status of this group of patients in order to make a proper assessment of the situation and to develop protocols for its management. The purpose of the study was to conduct a systematic review to ascertain the oral health status of elderly patients admitted to institutions or hospitalized for a long period of time. Methods a systematic review of the literature published in two different databases (PubMed, Embase and Cochrane Library) was carried out, with 12 different combinations of keywords based on the following selection criteria: studies published in the last 5 years, in English and/or Spanish and/or Portuguese, with samples of ≥ 30 patients, performed in patients older than 65 years, admitted to any type of institution and/or hospital center for at least 7 days and in which the state of hard and/or soft tissues of the oral cavity were evaluated in some way. The selected articles were subjected to a thorough analysis. Results The search strategy covered 1,014 articles: 689 from Pubmed and 325 from Cochrane Library. After applying the eligibility criteria, five articles were selected for our review. The level of evidence of the articles was3, a sample of 773 patients most of them were women with an average age older than 70 years old. Conclusions the oral health of patients aged more than 65 is worse than that of the rest population. Long hospital stays or being institutionalized in a residence makes this group susceptible to a worsening of their oral health status. It is necessary to develop protocols for the oral health care of these patients, accompanied by training programs for the personnel responsible.

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