The Use of Postoperative Antibiotics Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic Review and Meta-analysis

2021 ◽  
pp. 194589242198914
Author(s):  
Chloe E. Swords ◽  
Jeremy J. Wong ◽  
Kara N. Stevens ◽  
Alkis J. Psaltis ◽  
Peter J. Wormald ◽  
...  
Keyword(s):  
Adverse Events ◽  
Chronic Rhinosinusitis ◽  
Outcome Measures ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Sinus Surgery ◽  
Significant Difference ◽  
Patient Reported

Background Endoscopic sinus surgery is performed for medically recalcitrant chronic rhinosinusitis. There is no universally accepted strategy regarding post-operative antibiotics despite the high rates of usage worldwide. The aim of this study was to analyse patient-reported and objective outcomes behind antibiotic use following endoscopic sinus surgery. Methods A search of electronic databases was performed. Eligible randomised controlled trials (RCTs) and observational trials were included. The primary outcome was patient reported outcome measures. Secondary outcomes were local infections, endoscopy scores and adverse events. Meta-analysis was performed. Results Of 1045 publications identified, 7 were included in the qualitative synthesis and 5 RCTs were included in meta-analysis. Antibiotic regimens varied between studies in terms of antibiotic selection, timing commenced and duration of use. Meta-analysis suggested no significant difference between placebo and antibiotics in patient reported outcome measures (standardised mean difference (SMD) –0.215, 95% confidence interval (CI) –0.637 to 0.207) or endoscopic scores (SMD –2.86, 95% CI –0.846 to 0.273). There was no consistent definition in reporting of infection; therefore, this outcome cannot be comprehensively considered. No severe adverse events were attributable to antibiotics. Conclusions From the studies analysed, there is no level 1 evidence to suggest that antibiotics improved patient outcomes following sinus surgery. However, there was significant heterogeneity in outcome measures and no clear data exists regarding the effects of antibiotics on postoperative infections. The available evidence at present is not enough to make a recommendation in either direction. Further designed larger RCTs are required to investigate these questions in more detail.

A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis

2019 ◽  
Vol 30 (5) ◽  
pp. 513-522
Author(s):  
Satish Babu ◽  
Prashant Singh ◽  
Anatole Wiik ◽  
Oliver Shastri ◽  
Khalid Malik ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Total Hip Replacements ◽  
Significant Difference ◽  
Patient Reported ◽  
Hip Replacements ◽  
Meta Analyses

Introduction: Short stem hip replacements may allow preservation of proximal bone stock and minimise soft tissue disruption, easing future revision surgery. However patient satisfaction with these implants must be determined before widespread use. We aimed to compare patient reported outcome measures (PROMs) between short and conventional stem hip replacements. Methods: A systematic review was conducted according to PRISMA guidelines for studies comparing short and conventional stem hip replacements with validated PROMs. Meta-analyses were performed for studies reporting Harris Hip and WOMAC scores. Study bias was assessed with the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Results: 24 studies, incorporating 2593 total hip replacements were included for qualitative analysis. 17 studies were included in the meta-analyses. Of the 7 excluded, 1 study reported the Japanese Orthopaedic Association score and 2 others reported the Oxford Hip score. All three showed no difference between the stems. A meta-analysis of 17 studies reporting Harris hip scores showed no statistically significant difference between short and conventional stems (standard mean difference (SMD) −0.06, 95% CI −0.20—0.07, p = 0.35). 6 studies reported WOMAC scores with higher scores indicating worse outcome. No difference was seen between the two groups (SMD 0.21, 95%CI, −0.01—0.42, p = 0.06). 4 studies reported higher WOMAC scores as better. Once again, a meta-analysis showed no statistically significant difference between the stems (SMD 0.28, 95% CI −0.07—0.63, p = 0.12). Conclusions: Our systematic review showed no difference in PROMs between short and conventional stem total hip replacements. This is in keeping with previous evidence but is a more comprehensive analysis. Short stems may have an important role in younger individuals as they allow preservation of proximal femoral bone, minimal access surgery and are amenable to abnormal anatomy. The current literature is hindered by non-uniform methodologies and outcome assessments across studies. Further, standardised, high quality evidence is required before widespread changes in practice.

Systematic Review of Patient-Reported Outcomes after Revision Endoscopic Sinus Surgery

2017 ◽  
Vol 31 (4) ◽  
pp. 248-255 ◽  
Author(s):  
Shashi Prasad ◽  
Eric Fong ◽  
Eng H. Ooi
Keyword(s):  
Systematic Review ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Sinus Surgery ◽  
Patient Response ◽  
Postnasal Drip ◽  
Patient Reported ◽  
The Impact

Background Revision endoscopic sinus surgery (RESS) may be required for partially controlled or uncontrolled chronic rhinosinusitis. Studies that reported technical success, e.g., sinus ostia patency after RESS, do not address whether the patient's symptoms and quality of life (QOL) improve after surgery. However, patient-reported outcome measures (PROM) are useful to assess the impact of sinus surgery on a patient's symptoms and QOL. Objective This systematic review was undertaken to evaluate the impact of RESS on PROMs. Methods Medical literature databases were searched for studies in English. References from retrieved articles and relevant reviews were examined for additional studies. Those studies that reported QOL outcome tools in patients who underwent RESS and with a minimum follow-up of 6 months were included. Results A search of the sources yielded 1856 citations. There were 72 articles after abstract review and exclusion, identified for full-text review, with 12 studies (which contained data from 1308 patients) that met the inclusion criteria for this systematic review. There were four “good” and eight “fair” studies. Three studies used the Rhinosinusitis Disability Index and Chronic Sinusitis Survey in tandem; two each used the 20-item Sino-Nasal Outcome Test and the 22-item Sino-Nasal Outcome Test; the remaining studies used either the Adelaide Disease Severity Score, Patient Response Score (PRS), Rhinosinusitis Symptom Inventory, Rhinosinusitis Outcome Measure 31, or the Chinese version of the University of Pennsylvania Smell Identification Test. All studies used validated PROMs apart from the study that used PRS. Studies consistently reported improvement in the five key symptoms of nasal obstruction, rhinorrhea, postnasal drip, facial pain, and anosmia, although improvement in halitosis, fever, dental pain, and cough were modest. Conclusion Several PROMs demonstrated that RESS improves patient's QOL symptoms. Future studies that examine QOL should use a consistent PROM to allow a meta-analysis.

scholarly journals What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Nadim Saydy ◽  
Sami P. Moubayed ◽  
Marie Bussières ◽  
Arif Janjua ◽  
Shaun Kilty ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Patient Reported Outcome ◽  
Sinus Surgery ◽  
Structured Interviews ◽  
Subjective Data ◽  
Operative Outcomes ◽  
Patient Reported ◽  
Definition Of Success ◽  
Reported Data

Abstract Objectives Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. Methods A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. Results According to an expert survey, patients’ main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. Conclusions According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2). Graphical abstract

scholarly journals Conservative management acutely improves functional movement and clinical outcomes in patients with pre-arthritic hip pain

2020 ◽  
Vol 7 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Ryan P McGovern ◽  
RobRoy L Martin ◽  
Amy L Phelps ◽  
Benjamin R Kivlan ◽  
Beth Nickel ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Conservative Management ◽  
Movement Control ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Hip Pain ◽  
Analysis Of Covariance ◽  
Functional Movement ◽  
Significant Difference ◽  
Patient Reported

Abstract Conservative management for individuals with pre-arthritic hip pain is commonly prescribed prior to consideration of surgical management. The purpose of this study is to determine if patients with pre-arthritic hip pain will improve their functional movement control and clinical outcome measures following the implementation of physical therapy and a home-exercise programme. Information was retrospectively collected on consecutive patients and included: demographics, diagnosis, initial and follow-up evaluation of the single leg squat test (SLST) and step-down test (SDT), and patient-reported outcome measures. An independent t-test and one-way analysis of covariance were performed for continuous patient-reported outcome measures and a Fisher’s exact test was performed for patient satisfaction. Forty-six patients (31 female and 15 male) diagnosed with pre-arthritic hip pain were included. A total of 30 patients improved their functional movement control during performance of the SLST, whereas 31 patients improved performance of the SDT. There was a statistically significant difference between patients that improved and did not improve (P ≤ 0.017). Patients with pre-arthritic hip pain who improved their functional movement control following a prescribed rehabilitation intervention are likely to report less pain and greater functional ability in their daily and sports-related activities. This study supports conservative management to acutely improve outcomes for patients with pre-arthritic hip pain.

Readability of patient‐reported outcome measures for chronic rhinosinusitis and skull base diseases

2019 ◽  
Vol 130 (10) ◽  
pp. 2305-2310
Author(s):  
Saangyoung E. Lee ◽  
Zainab Farzal ◽  
Adam J. Kimple ◽  
Brent A. Senior ◽  
Brian D. Thorp ◽  
...  
Keyword(s):  
Skull Base ◽  
Chronic Rhinosinusitis ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported

scholarly journals Mid-term Prospective Follow-up of Ankle Fracture Fixation Using Patient Reported Outcome Measures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0039
Author(s):  
Paul Rai ◽  
Jitendra Mangwani
Keyword(s):  
Outcome Measures ◽  
Ankle Fracture ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Ankle Fractures ◽  
Anatomical Reduction ◽  
Clear Space ◽  
Significant Difference ◽  
Patient Reported

Category: Trauma Introduction/Purpose: Open reduction and internal fixation (ORIF) is a common procedure to stabilise unstable ankle fractures. Anatomical reduction and stable fixation is desirable to achieve good clinical and radiological outcome after this injury. This prospective study examines the correlation between mid-term patient reported outcome measures (PROMs) and quality of fracture reduction of adult patients with ankle fractures treated with ORIF. Methods: A total of 100 patients with unstable ankle fracture who underwent ORIF were prospectively entered into the study between Nov 2013 to Oct 2014. Exclusion criteria were: age <18 years, pathological or open fractures and patients with cognitive impairment. Two independent observers assessed fracture patterns and quality of reduction. Fixations were analysed using Pettrone’s criteria including assessment of fracture displacement, medial clear space and tibiofibular overlap. Patients were followed up at two years post-operatively with postal questionnaires. Validated PROMs, Olerud-Molander Score (OMAS) and the Lower Extremity Functional Scale (LEFS) were used. For both scores a higher number indicated a better result. Co-morbidities and infection data were collated from Hospital records. Results: At 2 years post-op there were 5 deceased patients,17 did not have accessible radiographs and there was a 65% response rate to questionnaires. 46 patients were included in the final study group with a mean age of 45 (16-90). There was 1 Weber A fracture, 26 Weber B, 16 Weber C and 3 Medial malleolus fractures. 7% had Diabetes Mellitus, 22% were smokers. The mean OMAS score was 71.4(SD26.9) and LEFS score 56.7(SD25.9). There was no significant difference in PROM scores when fracture fragment reduction was optimised. There was a significant improvement in PROMs with low medial clear space and high tibiofibular overlap. Conclusion: This study reports a good correlation between quality of reduction and favourable PROMs at 2 years post ORIF ankle fracture. Reduced medial clear space and increased tibiofibular overlap were most associated with good outcome scores. Anatomical reduction of fracture fragments did not appear to affect PROMs on its own. There was very little infection in this cohort to confound the results. We would advise careful consideration of medial clear space and tibiofibular overlap in particular at time of fixation of unstable ankle fractures.

scholarly journals Patient-reported outcome measures for adult chronic rhinosinusitis: A systematic review and quality assessment

2015 ◽  
Vol 136 (6) ◽  
pp. 1532-1540.e2 ◽  
Author(s):  
Luke Rudmik ◽  
Claire Hopkins ◽  
Anju Peters ◽  
Timothy L. Smith ◽  
Rodney J. Schlosser ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Chronic Rhinosinusitis ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported
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