scholarly journals Aspiration versus peritoneal lavage in appendicitis: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Gloria Burini ◽  
Maria Chiara Cianci ◽  
Marco Coccetta ◽  
Alessandro Spizzirri ◽  
Salomone Di Saverio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Wound Infection ◽  
Operative Time ◽  
Peritoneal Lavage ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Laparoscopic Group ◽  
Reoperation Rate ◽  
Abdominal Abscess ◽  
Surgical Emergencies

Abstract Background Acute appendicitis is one of the most frequent abdominal surgical emergencies. Intra-abdominal abscess is a frequent post-operative complication. The aim of this meta-analysis was to compare peritoneal irrigation and suction versus suction only when performing appendectomy for complicated appendicitis. Methods According to PRISMA guidelines, a systematic review was conducted and registered into the Prospero register (CRD42020186848). The risk of bias was defined to be from low to moderate. Results Seventeen studies (9 RCTs and 8 CCTs) were selected, including 5315 patients. There was no statistical significance in post-operative intra-abdominal abscess in open (RR 1.27, 95% CI 0.75–2.15; I2 = 74%) and laparoscopic group (RR 1.51, 95% CI 0.73–3.13; I2 = 83%). No statistical significance in reoperation rate in open (RR 1.27, 95% CI 0.04–2.49; I2 = 18%) and laparoscopic group (RR 1.42, 95% CI 0.64–2.49; I2 = 18%). In both open and laparoscopic groups, operative time was lower in the suction group (RR 7.13, 95% CI 3.14–11.12); no statistical significance was found for hospital stay (MD − 0.39, 95% CI − 1.07 to 0.30; I2 = 91%) and the rate of wound infection (MD 1.16, 95% CI 0.56–2.38; I2 = 71%). Conclusions This systematic review has failed to demonstrate the statistical superiority of employing intra-operative peritoneal irrigation and suction over suction-only to reduce the rate of post-operative complications after appendectomy, but all the articles report clinical superiority in terms of post-operative abscess, wound infection and operative times in suction-only group.

scholarly journals Comparative Evaluation of Open and Laproscopic Method of Appendectomy in Acute Appendicitis

2020 ◽  
Vol 3 (1) ◽  
pp. 8-11
Author(s):  
Amarnath Gupta ◽  
A P Singh
Keyword(s):  
Laparoscopic Surgery ◽  
Acute Appendicitis ◽  
Wound Infection ◽  
Operative Time ◽  
Laparoscopic Group ◽  
Oral Feeding ◽  
Open Group ◽  
Abdominal Abscess ◽  
Average Hospital ◽  
Open Operation

Background: There is definitely added advantage of laparoscopic operations. Most of the surgeons now prefer these minimally invasive proce- dures. Laparoscopy has become the number one choice of educated and affording patients. The aim of the study was to compare and evaluate the open and laproscopic method of appendectomy in acute appendicitis. Subjects and Methods: The subjects undergoing appendectomy  were evaluated for age, sex, episode number, duration of pain before presentation in hospital, operative time, conversion rate, wound infection, post-operative intra-abdominal abscess formation, and stay in hospital. Results: It was found that average operative time in open surgery was 67.5 minutes and 104 minutes in laparoscopic surgery, with a conversion to open in about 20% of the cases. Oral feeding in the open group was around the 5th day while it was around 2nd day in the laparoscopic group. Average hospital stay was also low in the laparoscopic group, being only around 5 days in laparoscopic group and around 8 days in the open group. Overall complications were also low in the laparoscopic surgery group. Conclusion: It was noted that though conversion to open operation was definitely high but there were other advantages of laparoscopic surgery as well. Stay in the hospital, beginning of oral feeds, requirement of analgesics, wound infection, intra-abdominal abscess; pulmonary complications were less in laparoscopy group.

Minimally Invasive Posterior Cervical Foraminotomy Versus Anterior Cervical Fusion and Arthroplasty: Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110550
Author(s):  
Andrew Platt ◽  
Richard G. Fessler ◽  
Vincent C. Traynelis ◽  
John E. O’Toole
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Operative Time ◽  
Meta Analysis ◽  
Reoperation Rate ◽  
Significant Difference ◽  
Posterior Cervical Foraminotomy ◽  
Postoperative Length ◽  
Cervical Foraminotomy

Study Design Systematic review and meta-analysis. Objectives Patients with lateral cervical disc and foraminal pathology can be treated with anterior and posterior approaches including anterior cervical discectomy and fusion(ACDF), cervical total disc arthroplasty(TDA), and minimally invasive posterior cervical foraminotomy(MIS-PCF). Although MIS-PCF may have some advantages over the anterior approaches, few comparative studies and meta-analyses have been done to assess superiority. Methods This study includes a systematic review of the literature and meta-analysis of studies directly comparing minimally invasive posterior cervical foraminotomy to either anterior cervical discectomy and fusion or cervical total disc arthroplasty. Results In comparing patients undergoing ACDF and MIS-PCF, operative time ranged from 68 to 97.8 minutes in the ACDF group compared to 28 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 33.84 to 112.8 hours in the ACDF group compared to 13.68 to 83.6 hours in the MIS-PCF group. The total complication rates were 3.72% in the ACDF group and 3.73% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the complication rate between the two procedures(OR .91; 95% CI 0.13, 6.43; P = .92, I2 = 59%). The total reoperation rate was 3.5% in the ACDF group and 5.4% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the reoperation rate between the two procedures(OR .66; 95% CI 0.33, 1.33; P = .25, I2 = 0). In comparing patients undergoing TDA and MIS-PCF, operative time ranged from 90.3 to 106.7 minutes in the TDA group compared to 77.4 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 103.2 to 165.6 hours in the TDA group and 93.6 to 98.4 hours in the MIS-PCF group. The complication rate ranged from 23.5 to 28.6% in the TDA group and 0 to 14.3% in the MIS-PCF group. The overall reoperation rates were 2.6% in the TDA group and 10.2% in the MIS-PCF group. Conclusions There is no clear superiority between MIS-PCF and ACDF/TDA in terms of operative time, postoperative length of stay, or rate of complications/reoperations. Further studies with increased follow-up intervals >48 months, and higher sample sizes are necessary to determine the true superiority of MIS-PCF and anterior neck approaches in treatment of lateral disc and foraminal pathology.

A systematic review and meta-analysis on endovascular treatment as an attractive alternative for acute superior mesenteric venous thrombosis

Vascular ◽  
2021 ◽  
pp. 170853812199127
Author(s):  
Lixin Wang ◽  
Enci Wang ◽  
Fei Liu ◽  
Wei Zhang ◽  
Xiaolong Shu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Venous Thrombosis ◽  
Endovascular Treatment ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Published Data ◽  
Mesenteric Venous Thrombosis ◽  
Surgery Group

Objective This systematic review and meta-analysis evaluated the published data on the efficacy and safety of therapies for superior mesenteric venous thrombosis (SMVT), aiming to provide a reference and set of recommendations for clinical treatment. Methods Relevant databases were searched for studies published from 2000 to June 2020 on SMVT treated with conservative treatment, surgical treatment, or endovascular approach. Different treatment types were grouped for analysis and comparison, and odds ratios with corresponding 95% confidence intervals were calculated. The outcomes were pooled using meta-analytic methods and presented by forest plots. Results Eighteen articles, including eight on SMVT patients treated with endovascular therapies, were enrolled. The treatment effectiveness was compared between different groups according to the change of symptoms, the occurrence of complications, and mortality as well. The conservative treatment group had better efficacy compared to the surgery group (89.0% vs. 78.6%, P <0.05), and the one-year survival rate was also higher (94.4% vs. 80.0%, P >0.05), but without statistical significance. As for endovascular treatment, the effectiveness was significantly higher than the surgery group (94.8% vs. 75.2%, P <0.05), and the conservative treatment group as well (93.3% vs. 86.3%, P >0.05), which still requires further research for the lack of statistical significance. Conclusions Present findings indicate that anticoagulation, as conservative treatment should be the preferred clinical option in the clinic for SMVT, due to its better curative effect compared to other treatment options, including lower mortality, fewer complications, and better prognosis. Moreover, endovascular treatment is a feasible and promising approach that is worth in-depth research, for it is less invasive than surgery and has relatively better effectiveness, thus can provide an alternative option for SMVT treatment and may be considered as a reliable method in clinical.

scholarly journals Individual Resilience Interventions: A Systematic Review in Adult Population Samples over the Last Decade

2021 ◽  
Vol 18 (14) ◽  
pp. 7564
Author(s):  
Mafalda Ferreira ◽  
António Marques ◽  
Paulo Veloso Gomes
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Adult Population ◽  
Well Being ◽  
Eligibility Criteria ◽  
Individual Resilience ◽  
Literature Searches ◽  
Great Heterogeneity

Resilience interventions have been gaining importance among researchers due to their potential to provide well-being and reduce the prevalence of mental disorders that are becoming an increasing concern, especially in Western countries, because of the costs associated. The purpose of this systematic review is to identify the intervention studies carried out in the last decade in adult population samples, evaluate their methodological quality and highlight the trends of these types of interventions. This review was performed using systematic literature searches in the following electronic databases: B-on, PubMed, PsycNet and Science Direct. The application of eligibility criteria resulted in the inclusion of 38 articles, of which 33 were randomized controlled trials and the other five were nonrandomized controlled studies. Although most studies showed statistical significance for their results, these were constrained by the great heterogeneity of the studies, the lack of power of the samples and their fair methodological quality. Therefore, it is important to consolidate the theoretical basis and standardize certain methodologies so that the effects of the interventions can be compared through a meta-analysis.

scholarly journals Indicators of response to exercise training: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044676
Author(s):  
Arash Ardavani ◽  
Hariz Aziz ◽  
Bethan E Phillips ◽  
Brett Doleman ◽  
Imran Ramzan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Exercise Training ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Response Rates ◽  
Whole Body ◽  
Individual Response ◽  
Qualitative Synthesis ◽  
Exercise Response ◽  
High Intensity Interval

BackgroundMeans-based analysis of maximal rate of oxygen consumption (VO2max) has traditionally been used as the exercise response indicator to assess the efficacy of endurance (END), high intensity interval (HIIT) and resistance exercise training (RET) for improving cardiorespiratory fitness and whole-body health. However, considerable heterogeneity exists in the interindividual variability response to the same or different training modalities.ObjectivesWe performed a systematic review and meta-analysis to investigate exercise response rates in the context of VO2max: (1) in each training modality (END, HIIT and RET) versus controls, (2) in END versus either HIIT or RET and (3) exercise response rates as measured by VO2max versus other indicators of positive exercise response in each exercise modality.MethodsThree databases (EMBASE, MEDLINE, CENTRAL) and additional sources were searched. Both individual response rate and population average data were incorporated through continuous data, respectively. Of 3268 identified manuscripts, a total of 29 studies were suitable for qualitative synthesis and a further 22 for quantitative. Stratification based on intervention duration (less than 12 weeks; more than or equal to 12 weeks) was undertaken.ResultsA total of 62 data points were procured. Both END and HIIT training exhibited differential improvements in VO2max based on intervention duration. VO2max did not adequately differentiate between END and HIIT, irrespective of intervention length. Although none of the other exercise response indicators achieved statistical significance, LT and HRrest demonstrated common trajectories in pooled and separate analyses between modalities. RET data were highly limited. Heterogeneity was ubiquitous across all analyses.ConclusionsThe potential for LT and HRrest as indicators of exercise response requires further elucidation, in addition to the exploration of interventional and intrinsic sources of heterogeneity.

scholarly journals The Association between Periodontitis and Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis

2020 ◽  
Vol 29 (2) ◽  
pp. 211-217
Author(s):  
Karn Wijarnpreecha ◽  
Panadeekarn Panjawatanan ◽  
Wisit Cheungpasitporn ◽  
Frank J Lukens ◽  
Denise M Harnois ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Periodontal Pocket ◽  
Nonalcoholic Fatty Liver ◽  
Unadjusted Analysis

Background and Aims: Recent studies have suggested an association between periodontitis and nonalcoholic fatty liver disease (NAFLD) although the results were inconsistent. The current systematic review and meta- analysis was conducted with the aim to comprehensively investigate this possible association by identifying all relevant studies and combining their results together. Methods: A comprehensive literature review was conducted utilizing the MEDLINE and EMBASE databases through December 2019 to identify all studies that compared the risk of NAFLD among patients with periodontitis to individuals without periodontitis. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results: A total of five studies with 27,703 participants fulfilled the eligibility criteria and were included in the meta-analysis. All five studies reported the magnitude of association between NAFLD and periodontitis that was diagnosed based on the periodontal pocket depth of > 3.5-4 mm. The pooled OR of unadjusted analysis was 1.48 (95%CI: 1.15-1.89; I 2 92%). However, when adjusted results from the primary studies were used, pooled OR decreased to 1.13 and lost its statistical significance (95%CI: 0.95–1.35; I 2 67%). Three studies reported the magnitude of association between NAFLD and periodontitis that was diagnosed based on a clinical attachment level of ≥ 3 mm. The pooled OR of unadjusted analysis was 1.13 (95%CI: 1.07-1.20; I 2 0%). However, when adjusted results from the primary studied were used, pooled OR decreased to 1.08 and lost its statistical significance (95%CI: 0.94–1.24; I 2 58%). Conclusions: The study found a significant association between periodontitis and NAFLD. However, the association lost its significance when various metabolic parameters were adjusted, suggesting that those metabolic conditions, not periodontitis itself, were predisposing factors for NAFLD.

scholarly journals Effects of Anti-Diabetic Drugs on Fracture Risk: A Systematic Review and Network Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yu-Sheng Zhang ◽  
Yan-Dan Zheng ◽  
Yan Yuan ◽  
Shi-Chun Chen ◽  
Bao-Cheng Xie
Keyword(s):  
Systematic Review ◽  
Fracture Risk ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Treatment Strategies ◽  
Sex Distribution ◽  
Risk Of Fracture ◽  
Dipeptidyl Peptidase 4 ◽  
Combining Data ◽  
Glucagon Like Peptide 1

PurposeAvailable data on the effects of anti-diabetic drugs on fracture risk are contradictory. Therefore, our study aimed to analyze all available data on the effects of anti-diabetic drugs on fracture risk in type 2 diabetes mellitus (T2DM) patients.MethodsEmbase, Medline, ClinicalTrials.gov, and Cochrane CENTRAL were searched for relevant trials. All data analyses were performed with STATA (12.0) and R language (3.6.0). Risk ratio (RR) with its 95% confidence interval (CI) was calculated by combining data for the fracture effects of anti-diabetic drugs, including sodium–glucose co-transporter 2 (SGLT2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, meglitinides, α-glucosidase inhibitors, thiazolidinediones, biguanides, insulin, and sulfonylureas.ResultsOne hundred seventeen eligible randomized controlled trials (RCTs) with 221,364 participants were included in this study. Compared with placebo, trelagliptin (RR 3.51; 1.58–13.70) increased the risk of fracture, whereas albiglutide (RR 0.29; 0.04–0.93) and voglibose (RR 0.03; 0–0.11) decreased the risk of fracture. Other medications were comparable in terms of their effects on fracture risk, and no statistical significance was observed. In terms of fractures, voglibose (0.01%) may be the safest option, and trelagliptin (13.64%) may be the worst. Sensitivity analysis results were consistent with those of the main analysis. No statistically significant differences were observed in the regression coefficients of age (1.03; 0.32–2.1), follow-up duration (0.79; 0.27–1.64), and sex distribution (0.63; 0.15–1.56).ConclusionsWe found varied results on the association between the use of anti-diabetic drugs and fracture risk. Specifically, trelagliptin raised the risk of fracture, whereas voglibose and albiglutide showed benefit with statistical difference. Other drugs were comparable in terms of their effects on fracture risk. Some drugs (omarigliptin, sitagliptin, vildagliptin, saxagliptin, empagliflozin, ertugliflozin, rosiglitazone, pioglitazone, and nateglinide) may increase the risk of fracture, while others (such as dulaglutide, exenatide, liraglutide, semaglutide, lixisenatide, linagliptin, alogliptin, canagliflozin, dapagliflozin, glipizide, gliclazide, glibenclamide, glimepiride, metformin, and insulin) may show benefits. The risk of fracture was independent of age, sex distribution, and the duration of exposure to anti-diabetic drugs. When developing individualized treatment strategies, the clinical efficacy of anti-diabetic drugs must be weighed against their benefits and risks brought about by individual differences of patients.Systematic Review RegistrationThis Systematic Review was prospectively registered on the PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, registration number CRD42020189464).

715 Early Ambulation for Enhanced Recovery After Burn Surgery: A Systematic Review and Meta-analysis

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S189-S189
Author(s):  
Tomer Lagziel ◽  
Margarita Ramos ◽  
Kevin M Klifto ◽  
Stella Steal ◽  
Julie Caffrey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Burn Patients ◽  
Early Ambulation ◽  
Lengths Of Stay ◽  
Operative Care ◽  
Burn Surgery ◽  
Operative Recovery

Abstract Introduction Accurate models are a fundamental prognostic tool for risk stratification, therapy guidance, resource allocation, and comparative effectiveness research. Enhanced recovery after surgery protocols are developed to increase early post-operative recovery rates in surgical patients. Due to the unique nature of burn injuries and post-operative care, there is a need to develop a protocol unique to burn surgery, enhanced recovery after burn surgery. Methods The PubMed, Embase, Cochrane, and Web of Science databases were systematically searched. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines were strictly followed throughout the study. Search terms were utilized to capture the relevant studies relating to early ambulation of adult burn patients (&gt;18 years of age) and their post-surgical outcomes such as graft take, time to discharge, pain levels, VTEs, and length-of-stay. Results Thirteen of 888 studies retrieved from the search query were eligible for systematic review and meta-analysis. Patients with delayed ambulation, after 5 or more days were found to have increased pain levels at rest (p=0.02) and when ambulating (p=0.08). One study found an increased infection rate in late ambulatory patients (p=0.22). Most results from studies did not have significant data that was relevant to our extraction. For example, only one study assessed pain levels and only three studies notes zero venous thromboembolisms (without statistical significance). Conclusions Limited evidence exists relating to thromboembolic events and time-to-ambulation in post-operative burn patients. There are no significant differences in the number of events between early and late ambulation groups. Early ambulation should be included as part of the ERABS protocol for lower risks of hospital-acquired infections due to shorter lengths-of-stay. Decreased associated pain levels could lead to decreased risk for opioid dependence. Due to limited literature references, these conclusions are immature and more studies should be performed in order to develop more accurate and effective protocols. Applicability of Research to Practice Burn surgery recovery patients are unique. Therefore, specialized protocols must be developed to enhance their post-operative care.

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