scholarly journals Spine Surgery and Preoperative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review

2021 ◽  
pp. 219256822097982
Author(s):  
Krishna V. Suresh ◽  
Kevin Wang ◽  
Ishaan Sethi ◽  
Bo Zhang ◽  
Adam Margalit ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Spine Surgery ◽  
Postoperative Infection ◽  
Lumbar Fusion ◽  
Adult Patients ◽  
Cochrane Library ◽  
Cardiac Events ◽  
Level Of Evidence ◽  
Increased Risk

Study Design: Systematic review. Objectives: Synthesize previous studies evaluating clinical utility of preoperative Hb/Hct and HbA1c in patients undergoing common spinal procedures: anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), posterior lumbar fusion (PLF), and lumbar decompression (LD). Methods: We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on preoperative Hb/Hct and HbA1c and post-operative outcomes in adult patients undergoing ACDF, PCF, PLF, or LD surgeries. Results: Total of 4,307 publications were assessed. Twenty-one articles met inclusion criteria. PCF and ACDF: Decreased preoperative Hb/Hct were significant predictors of increased postoperative morbidity, including return to operating room, pulmonary complications, transfusions, and increased length of stay (LOS). For increased HbA1c, there was significant increase in risk of postoperative infection and cost of hospital stay. PLF: Decreased Hb/Hct was reported to be associated with increased risk of postoperative cardiac events, blood transfusion, and increased LOS. Elevated HbA1c was associated with increased risk of infection as well as higher visual analogue scores (VAS) and Oswestry disability index (ODI) scores. LD: LOS and total episode of care cost were increased in patients with preoperative HbA1c elevation. Conclusion: In adult patients undergoing spine surgery, preoperative Hb/Hct are clinically useful predictors for postoperative complications, transfusion rates, and LOS, and HbA1c is predictive for postoperative infection and functional outcomes. Using Hct values <35-38% and HbA1c >6.5%-6.9% for identifying patients at higher risk of postoperative complications is most supported by the literature. We recommend obtaining these labs as part of routine pre-operative risk stratification. Level of Evidence: III

scholarly journals Risk factors for postoperative stroke in adults patients with moyamoya disease: a systematic review with meta-analysis

2019 ◽  
Author(s):  
Wei Wei ◽  
Xin Chen ◽  
Yu Jun ◽  
Xuqin Li
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Postoperative Complications ◽  
Moyamoya Disease ◽  
Meta Analysis ◽  
Age At Onset ◽  
Adult Patients ◽  
Cochrane Library ◽  
Postoperative Stroke ◽  
Increased Risk

Abstract Background This systematic review and meta-analysis aimed to clarify the risk factors for postoperative stroke in adult patients with moyamoya disease (MMD). Methods We comprehensively searched MEDLINE/PubMed, Web of Science, and Cochrane Library for eligible published literature with regard to the risk factors and postoperative complications in adult patients with MMD. Statistical analysis was conducted using Stata version 12.0. Pooled odds ratio (OR) with 95% confidence interval (CI) were assessed for each risk factor. Results There were 8 studies encompassing 1649 patients who underwent surgery with MMD were selected for analysis. Preoperative ischemic event significantly increase the risk of postoperative stroke events (OR=1.40; 95%CI=1.02–1.92; P=0.039). PCA involvement correlate with an increased risk of post-infarction (OR=4.60; 95%CI=2.61–8.11; P=0.000). Compared to direct bypass, patients who underwent indirect bypass or combined bypass could significantly increase the risk of postoperative stroke events. (OR=1.17; 95%CI=1.03–1.33; p=0.017). MMD patients with diabetes were associated with an increased risk of postoperative stroke events (OR=4.02, 95% CI=1.59-10.16; p=0.003). MMD patients with hypertension, age at onset and male sex were not associated with an increased risk of postoperative stroke events (P>0.05). Conclusions This systematic review and meta-analysis indicated that preoperative ischemic events, PCA involvement and diabetes were independent risk factors for postoperative stroke in MMD patients. Therefore, in order to ensure the curative effect of patients with MMD, it is very necessary to detect these risk factors and prevent postoperative complications in time.

scholarly journals Risk factors for postoperative stroke in adults patients with moyamoya disease: a systematic review with meta-analysis

2019 ◽  
Author(s):  
Wei Wei ◽  
Xin Chen ◽  
Yu Jun ◽  
Xuqin Li
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Postoperative Complications ◽  
Moyamoya Disease ◽  
Meta Analysis ◽  
Age At Onset ◽  
Adult Patients ◽  
Cochrane Library ◽  
Postoperative Stroke ◽  
Increased Risk

Abstract Background: This systematic review and meta-analysis aimed to clarify the risk factors for postoperative stroke in adult patients with moyamoya disease (MMD). Methods: We comprehensively searched MEDLINE/PubMed, Web of Science, and Cochrane Library for eligible published literature with regard to the risk factors and postoperative complications in adult patients with MMD. Statistical analysis was conducted using Stata version 12.0. Pooled odds ratio (OR) with 95% confidence interval (CI) were assessed for each risk factor. Results: There were 8 studies encompassing 1649 patients who underwent surgery with MMD were selected for analysis. Preoperative ischemic event significantly increase the risk of postoperative stroke events (OR=1.40; 95%CI=1.02–1.92; P=0.039). PCA involvement correlate with an increased risk of post-infarction (OR=4.60; 95%CI=2.61–8.11; P=0.000). Compared to direct bypass, patients who underwent indirect bypass or combined bypass could significantly increase the risk of postoperative stroke events. (OR=1.17; 95%CI=1.03–1.33; p=0.017). MMD patients with diabetes were associated with an increased risk of postoperative stroke events (OR=4.02, 95 % CI=1.59-10.16; p=0.003). MMD patients with hypertension, age at onset and male sex were not associated with an increased risk of postoperative stroke events (P>0.05). Conclusions: This systematic review and meta-analysis indicated that preoperative ischemic events, PCA involvement and diabetes were independent risk factors for postoperative stroke in MMD patients. Therefore, in order to ensure the curative effect of patients with MMD, it is very necessary to detect these risk factors and prevent postoperative complications in time. Keywords: Moyamoya disease; Postoperative complication; Risk factors; Meta-analylsis.

scholarly journals Is hydroxychloroquine with macrolide a good combination in COVID-19 compared to hydroxychloroquine alone from cardiac perspective? A systematic review and meta-analysis

2020 ◽  
Author(s):  
Sitaram Khadka ◽  
Pravash Budhathoki ◽  
Dhan Bahadur Shrestha ◽  
Era Rawal
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cochrane Library ◽  
Cardiac Events ◽  
Level Of Evidence ◽  
Risk Of Mortality ◽  
Adverse Cardiac Events ◽  
Fixed And Random Effects ◽  
Quantitative Synthesis

Abstract Background: The global spread of COVID-19 and the lack of definite treatment has caused an alarming crisis in the world. Hydroxychloroquine (HCQ) and azithromycin (AZT) are considered a possible treatment option. We aimed to evaluate the outcome and potential harmful cardiac effects of AZT+HCQ compared to HCQ alone for COVID-19 treatment.Methods: Pubmed, Medline, Google Scholar, Cochrane Library, and clinicaltrials.gov were searched using appropriate keywords and identified six studies using PRISMA guidelines. The quantitative synthesis was performed using fixed and random effects for the pooling of studies. Result: In this systematic review and meta-analysis, the risk of mortality (RR 1.16; 0.92-1.46) and adverse cardiac events (OR 1.06; 0.82-1.37) demonstrated a small increment though of no significance. There are no increased odds of mechanical ventilation (OR 0.84; 0.33-2.15) and significant QTc prolongation (OR 0.84, 0.59-1.21). Neither the critical QTc threshold (OR 1.92, CI 0.81-4.56) nor absolute ΔQTc ≥60ms (OR 1.95, CI 0.55-6.96) is increased to the level of statistical significance among HCQ+AZT arm compared to HCQ alone; but its slightly increased odds need to be considered in clinical practice. Conclusion: The combination of AZT+HCQ leads to small increased odds of mortality and cardiac events compared to HCQ alone. It is of no statistical significance for the critical QTc threshold and absolute ΔQTc ≥60ms, but increased odds with HCQ+AZT arm need to be considered in clinical relevance. Our result does not guide against the use of combination or HCQ alone based on the present level of evidence.

scholarly journals Antiresorptive and anabolic medications used in the perioperative period of patients with osteoporosis undergoing spine surgery: their impact on the biology of fusion and systematic review of the literature

2021 ◽  
Vol 50 (6) ◽  
pp. E13
Author(s):  
Jean-Paul Bryant ◽  
Roberto J. Perez-Roman ◽  
S. Shelby Burks ◽  
Michael Y. Wang
Keyword(s):  
Systematic Review ◽  
Monoclonal Antibody ◽  
Spine Surgery ◽  
Perioperative Period ◽  
The United States ◽  
Mechanisms Of Action ◽  
Cochrane Library ◽  
Mineral Density ◽  
Anabolic Agents ◽  
Increased Risk

OBJECTIVE Osteoporosis represents the most common metabolic disease of the bone, with an estimated 10% of adults aged 50 years or older affected in the United States. This patient population is at increased risk for spine fracture and instrumentation-related complications after spine surgery. Surgeon knowledge of the available treatments for patients with low bone mineral density (BMD) and how they impact biology of fusion may help mitigate negative effects in the postoperative period. Recombinant parathyroid hormone, which is sold under the name teriparatide, is the most extensively studied bone-protecting agent in humans. Additionally, the success of the monoclonal antibody denosumab has led to further clinical investigations of human patients undergoing spine surgery. Another monoclonal antibody, romosozumab, was recently approved by the US FDA for human use in patients with osteoporosis. Although studies of romosozumab in patients undergoing spine surgery have not been conducted, this is a promising potential therapeutic agent based on its early success in preclinical and clinical trials. Here, the authors aimed to review the mechanisms of action and evidence of use of antiresorptive and anabolic agents in patients with osteoporosis undergoing spine surgery. METHODS In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted to explore the antiresorptive and anabolic agents used in the perioperative period in patients with osteoporosis undergoing spinal surgery. The search was performed by using the PubMed, Embase, and Cochrane Library databases. Titles and abstracts were screened and subsequently selected for full review. RESULTS The initial search returned 330 articles. Of these articles, 23 final articles were included and reviewed. Many of these articles reported that use of adjuvant agents in the perioperative period improved radiographic evidence of bony fusion and bone fusion rates. These agents tended to improve BMD postoperatively. CONCLUSIONS Although antiosteoporosis agents are effective to varying degrees as treatments of patients with low BMD, teriparatide and bisphosphonates have been the most extensively studied with respect to spinal instrumentation. The advent of newer agents represents an area for further exploration, especially due to the current paucity of controlled investigations. It is imperative for spine surgeons to understand the mechanisms of action of these drugs and their effects on biology of fusion.

scholarly journals EXPRESS: Stroke risk following traumatic brain injury: systematic review and meta-analysis

2021 ◽  
pp. 174749302110042
Author(s):  
Grace Mary Turner ◽  
Christel McMullan ◽  
Olalekan Lee Aiyegbusi ◽  
Danai Bem ◽  
Tom Marshall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Cochrane Library ◽  
Control Group ◽  
Large Sample Size ◽  
Hazard Ratios ◽  
Increased Risk ◽  
The Cochrane Library

Aims To investigate the association between TBI and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4th December 2020. We used random-effects meta-analysis to pool hazard ratios (HR) for studies which reported stroke risk post-TBI compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-TBI control group, all found TBI patients had significantly increased risk of stroke compared to controls (pooled HR 1.86; 95% CI 1.46-2.37). Findings suggest stroke risk may be highest in the first four months post-TBI, but remains significant up to five years post-TBI. TBI appears to be associated with increased stroke risk regardless of severity or subtype of TBI. There was some evidence to suggest an association between reduced stroke risk post-TBI and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants. Conclusion TBI is an independent risk factor for stroke, regardless of TBI severity or type. Post-TBI review and management of risk factors for stroke may be warranted.

Executive functions in children with heart disease: a systematic review and meta-analysis

2021 ◽  
pp. 1-9
Author(s):  
William M. Jackson ◽  
Nicholas Davis ◽  
Johanna Calderon ◽  
Jennifer J. Lee ◽  
Nicole Feirsen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Executive Functions ◽  
Data Extraction ◽  
Meta Analysis ◽  
Executive Dysfunction ◽  
Cochrane Library ◽  
Planning Problem ◽  
Healthy Controls ◽  
Cross Sectional ◽  
Increased Risk

Abstract Context: People with CHD are at increased risk for executive functioning deficits. Meta-analyses of these measures in CHD patients compared to healthy controls have not been reported. Objective: To examine differences in executive functions in individuals with CHD compared to healthy controls. Data sources: We performed a systematic review of publications from 1 January, 1986 to 15 June, 2020 indexed in PubMed, CINAHL, EMBASE, PsycInfo, Web of Science, and the Cochrane Library. Study selection: Inclusion criteria were (1) studies containing at least one executive function measure; (2) participants were over the age of three. Data extraction: Data extraction and quality assessment were performed independently by two authors. We used a shifting unit-of-analysis approach and pooled data using a random effects model. Results: The search yielded 61,217 results. Twenty-eight studies met criteria. A total of 7789 people with CHD were compared with 8187 healthy controls. We found the following standardised mean differences: −0.628 (−0.726, −0.531) for cognitive flexibility and set shifting, −0.469 (−0.606, −0.333) for inhibition, −0.369 (−0.466, −0.273) for working memory, −0.334 (−0.546, −0.121) for planning/problem solving, −0.361 (−0.576, −0.147) for summary measures, and −0.444 (−0.614, −0.274) for reporter-based measures (p < 0.001). Limitations: Our analysis consisted of cross-sectional and observational studies. We could not quantify the effect of collinearity. Conclusions: Individuals with CHD appear to have at least moderate deficits in executive functions. Given the growing population of people with CHD, more attention should be devoted to identifying executive dysfunction in this vulnerable group.

Infrared Thermography for the Evaluation of Inflammatory and Degenerative Joint Diseases: A Systematic Review

Cartilage ◽  
2021 ◽  
Vol 13 (2_suppl) ◽  
pp. 1790S-1801S
Author(s):  
Guglielmo Schiavon ◽  
Gianluigi Capone ◽  
Monique Frize ◽  
Stefano Zaffagnini ◽  
Christian Candrian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Progression ◽  
Infrared Thermography ◽  
Rheumatic Diseases ◽  
English Language ◽  
Response To Treatment ◽  
Cochrane Library ◽  
Joint Diseases ◽  
Level Of Evidence ◽  
Post Evaluation

Objective Inflammation plays a central role in the pathophysiology of rheumatic diseases as well as in osteoarthritis. Temperature, which can be quantified using infrared thermography, provides information about the inflammatory component of joint diseases. This systematic review aims at assessing infrared thermography potential and limitations in these pathologies. Design A systematic review was performed on 3 major databases: PubMed, Cochrane library, and Web of Science, on clinical reports of any level of evidence in English language, published from 1990 to May 2021, with infrared thermography used for diagnosis of osteoarthritis and rheumatic diseases, monitoring disease progression, or response to treatment. Relevant data were extracted, collected in a database, and analyzed for the purpose of this systematic review. Results Of 718 screened articles 32 were found to be eligible for inclusion, for a total of 2094 patients. Nine studies reported the application to osteoarthritis, 21 to rheumatic diseases, 2 on both. The publication trend showed an increasing interest in the last decade. Seven studies investigated the correlation of temperature changes with osteoarthritis, 16 with rheumatic diseases, and 2 with both, whereas 2 focused on the pre-post evaluation to investigate treatment results in patients with osteoarthritis and 5 in patients with rheumatic diseases. A correlation was shown between thermal findings and disease presence and stage, as well as the clinical assessment of disease activity and response to treatment, supporting infrared thermography role in the study and management of rheumatic diseases and osteoarthritis. Conclusions The systematic literature review showed an increasing interest in this technology, with several applications in different joints affected by inflammatory and degenerative pathologies. Infrared thermography proved to be a simple, accurate, noninvasive, and radiation-free method, which could be used in addition to the currently available tools for screening, diagnosis, monitoring of disease progression, and response to medical treatment.

scholarly journals The effect of hemodilution on free flap survival: A systematic review of clinical and experimental studies

2020 ◽  
Vol 75 (4) ◽  
pp. 457-466
Author(s):  
Matteo Amoroso ◽  
Peter Apelgren ◽  
Anna Elander ◽  
Karin Säljö ◽  
Lars Kölby
Keyword(s):  
Systematic Review ◽  
Literature Search ◽  
Experimental Studies ◽  
Free Flaps ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Grade Scale ◽  
Reconstructive Microsurgery ◽  
The Cochrane Library

BACKGROUND: Acute normovolemic hemodilution (ANH) has been proposed as a microsurgical technique to improve blood flow in free flaps. OBJECTIVE: Here, we present the first systematic review of clinical and experimental studies on the effect of ANH. METHODS: We performed a systematic literature search of PubMed, Medline, the Cochrane Library, Google Scholar, and ClinicalTrials.gov using search strategies and a review process in agreement with the PRISMA statement and the Cochrane Handbook for systematic reviews of interventions. PICO criteria were defined before bibliometric processing of the retrieved articles, which were analyzed with the SYRCLE RoB tool for risk of bias and the GRADE scale for level of evidence. RESULTS: We retrieved 74 articles from the literature search, and after processing according to PICO criteria, only four articles remained, all of which were experimental. The rating for risk of bias was uncertain according to SYRCLE RoB results, and the level of evidence was low according to GRADE evaluation. CONCLUSIONS: There is no clinical evidence for the effect of ANH on microcirculation in free flaps, and experimental studies provide weak evidence supporting the use of hemodilution in reconstructive microsurgery.

Occult Metastasis in Laryngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 130 (1) ◽  
pp. 67-77
Author(s):  
Daniel D. Sharbel ◽  
Mary Abkemeier ◽  
Michael W. Groves ◽  
William G. Albergotti ◽  
J. Kenneth Byrd ◽  
...  
Keyword(s):  
Systematic Review ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Distant Metastasis ◽  
Laryngeal Squamous Cell Carcinoma ◽  
Cochrane Library ◽  
Elective Neck Dissection ◽  
Occult Metastasis ◽  
Level Of Evidence

Objective: The incidence of occult metastasis (OM) in laryngeal squamous cell carcinoma (SCC) is still widely debated. In this systematic review, we aim to determine the rate of OM in laryngeal SCC, its impact on recurrence, and the role of elective neck dissection (END) in the management of the clinically negative neck. Methods: A systematic review of the English-language literature in Web of Science, PubMed, MEDLINE, and Cochrane Library databases on occult metastasis in laryngeal SCC from 1977 to 2018 was conducted. Studies evaluating occult metastasis (OM) in patients with laryngeal SCC with clinically negative necks undergoing surgery were included. Studies evaluating other head and neck subsites, clinically node positive, and salvage patients were excluded. Results: Twenty-one articles with a total of 5630 patients were included. The overall rate of OM was 20.5% and was 23% and 12.2% in supraglottic and glottic tumors, respectively. The OM rate in T1-T2 tumors was 13% and 25% in T3-T4 tumors. T3-T4 tumors had significantly greater odds of developing OM compared to T1-T2 tumors (Odds Ratio [OR] = 2.61, 95% Confidence Interval [CI] = 1.92-3.55, P < .00001). Patients with OM were more likely to develop distant metastasis (OR = 5.65, 95% CI = 3.36-9.51, P < .00001). Conclusions: Patients with advanced T-stage laryngeal SCC should undergo elective neck treatment. More aggressive treatment for patients with history of OM should be considered due to the risk of subsequent regional and distant metastasis. Level of Evidence: II

scholarly journals Safety and Efficacy of Therapeutic Taping in Primary Dysmenorrhea: a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Bandara EMIA ◽  
Kularathne WNI ◽  
K Brain ◽  
Weerasekara I
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Adult Women ◽  
Primary Dysmenorrhea ◽  
Level Of Evidence ◽  
Effective Measure ◽  
Safety And Efficacy ◽  
Pain Anxiety

Abstract Primary dysmenorrhea (PD) is a common gynecological complaint among adolescents and adult women. Various pharmacological and alternative therapies such as therapeutic taping have been used as a treatment of PD. Although several studies have been conducted to evaluate the safety and efficacy of therapeutic taping in PD, these studies have not provided adequate level of evidence related to the safety and efficacy of therapeutic taping in PD. Hence, a systematic review and meta-analysis was performed to evaluate the safety and efficacy of therapeutic taping in PD. The following databases; Medline, Cochrane Library, Embase, PEDro, CINAHL and any other gray literature sources were searched for randomized controlled trials (RCTs) that used therapeutic taping to treat PD from inception to June 2021 with the language restricted to English. Independently screened articles by two reviewers were extracted according to the study objectives. A total of nine studies were included in the systematic review, involving 577 participants. Three studies were eligible for meta-analysis to find the pooled effect of taping on pain intensity. The review indicates that therapeutic taping is an effective measure in improving pain, anxiety and quality of life of women with PD. Meta-analysis conducted to compare the effect of elastic therapeutic taping (ETT) to sham taping showed that the ETT is an effective measure in improving pain among women with PD (MD = -3.12 (95% CI -5.64, -0.60); p=0.02; I2=95 %). The quality of the studies was assessed using the PEDro scale and the included RCTs indicated a fair to good level of quality. Our systematic review and meta-analysis demonstrated that therapeutic taping is an effective intervention for PD. However, RCTs with higher quality and larger sample sizes are necessary to verify the current results of the review.

Sign in / Sign up

Export Citation Format

Share Document