Enhanced recovery programmes versus conventional care in bariatric surgery: A systematic literature review and meta-analysis

Background With obesity prevalence projected to increase, the demand for bariatric surgery will consequently rise. Enhanced recovery programmes aim for improved recovery, earlier discharge, and more efficient use of resources following surgery. This systematic literature review aimed to evaluate the evidence available on the effects of enhanced recovery programmes after three common bariatric procedures: laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), and one anastomosis gastric bypass (OAGB). Methods MEDLINE, Embase, the Cochrane Library and the National Health Service Economic Evaluation Database were searched for studies published in 2012–2019 comparing outcomes with enhanced recovery programmes versus conventional care after bariatric surgery in Europe, the Middle East and Africa. Data were extracted and meta-analyses or descriptive analyses performed when appropriate using R. Results Of 1152 screened articles, seven relevant studies including 3592 patients were identified. Six reported outcomes for 1434 patients undergoing LRYGB; however, as only individual studies reported on LSG and OAGB these could not be included in the analyses. The meta-analysis revealed a significantly shorter mean duration of hospital-stay for LRYGB enhanced recovery programmes than conventional care (mean difference [95% CI]: -1.34 days [-2.01, -0.67]; p<0.0001), supported by sensitivity analysis excluding retrospective studies. Meta-analysis found no significant difference in 30-day readmission rate (risk ratio [95% CI]: 1.39 [0.84, 2.28]; p = 0.2010). Complication rates were inconsistently reported by Clavien-Dindo grade, but descriptive analysis showed generally higher low-grade rates for enhanced recovery programmes; the trend reversed for high-grade complications. Reoperation rates were rarely reported; no significant differences were seen. Conclusion These results support enhanced recovery programmes allowing shorter inpatient stay without significant differences in readmission rate following LRYGB, although complication and reoperation rate comparisons were inconclusive. Further research is needed to fill current data gaps including the lack of studies on LSG and OAGB.

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Evolution of GERD symptoms after bariatric surgery: A dose- response meta-analysis

10.21203/rs.3.rs-408294/v1 ◽

2021 ◽

Author(s):

Abdelnaser Elzouki ◽

Muhammad-Aamir Waheed ◽

Salah Suwileh ◽

Hisham Swehli ◽

Maryam Alhitmi ◽

...

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Dose Response ◽

Data Extraction ◽

Gastric Bypass Surgery ◽

Meta Analysis ◽

Symptomatic Improvement ◽

Favorable Effect ◽

Cochrane Library ◽

Gerd Symptoms

Abstract Importance Obesity is associated with increased prevalence of gastroesophageal reflux disease (GERD); with recent reports suggesting improvement in GERD symptoms and weight loss following bariatric surgical intervention. However, the exact impact of the type of bariatric surgery on the evolution of GERD symptoms have remained unexamined. Objective To characterize the exact evolution of GERD symptoms, post bariatric surgery.Data sources We systematically searched electronic databases (PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to December 2018) for eligible studies that satisfy pre-specified inclusion criteria. Study selection We included clinical trials of all designs (prospective and retrospective) that reported on GERD outcomes following Laparoscopic Sleeve Gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB).Data extraction and synthesis Two independent reviewers extracted relevant data based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were pooled using a random-effects model.Main outcomes Symptomatic improvement in GERD symptoms following bariatric surgery Results A total of 39 studies were analyzed and a robust-error meta-regression model was used to conduct a Dose-Response Meta-Analysis (DRMA) synthesizing data on 39 studies that reported GERD outcomes after bariatric surgery. Out of 43,994 patients who underwent either LSG (N = 9,547 patients) or LRYGB (N = 34,447 patients), 32.4% experienced improvement in symptoms (95% CI 20.62 to 45.45); The DRMA demonstrated a window period of two years for sustained improvement after which symptoms began to recur in those that were asymptomatic. Conclusion and relevance Bariatric surgery may improve GERD symptoms in obese patients who underwent LSG, however, the most favorable effect is likely to be found after Roux-en-Y gastric bypass surgery. The effects were not sustained and returned to baseline within 4 years.

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Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence

Frontiers in Neurology ◽

10.3389/fneur.2021.662856 ◽

2021 ◽

Vol 12 ◽

Author(s):

Tina S. Ipe ◽

Adeola R. Davis ◽

Jay S. Raval

Keyword(s):

Literature Review ◽

Myasthenia Gravis ◽

Plasma Exchange ◽

Systematic Literature Review ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Treatment Options ◽

Therapeutic Plasma Exchange ◽

Cochrane Library ◽

Pubmed Database

Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG.Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library.Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis.Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy. There was no difference in mortality between the two treatment options. Our findings highlight the need for additional randomized clinical trials in these patients with MG.

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FRACTURE RISK AFTER BARIATRIC SURGERY: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS

Endocrine Practice ◽

10.1016/j.eprac.2021.09.007 ◽

2021 ◽

Author(s):

Narriane Chaves Pereira de Holanda ◽

Ingrid de Lima Carlos ◽

Caio Chaves de Holanda Limeira ◽

David Cesarino de Sousa ◽

Fábio Antônio Serra de Lima Junior ◽

...

Keyword(s):

Bariatric Surgery ◽

Literature Review ◽

Fracture Risk ◽

Systematic Literature Review ◽

Meta Analysis

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Enhanced recovery after surgery for hip fractures: a systematic review and meta-analysis

Perioperative Medicine ◽

10.1186/s13741-021-00201-8 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Song-yang Liu ◽

Ci Li ◽

Pei-xun Zhang

Keyword(s):

Hip Fractures ◽

Complication Rate ◽

Readmission Rate ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Meta Analysis ◽

Fracture Repair ◽

Cochrane Library ◽

Control Group ◽

Clinical Prognosis

Abstract Background Enhanced recovery after surgery (ERAS) programs have achieved promising results in many surgical specialties. However, uncertainty still remains regarding the effect of ERAS on hip fractures. The objective of this review was to investigate the clinical prognosis of ERAS programs in terms of (1) hospital-related endpoints (time to surgery [TTS], length of stay [LOS]), (2) readmission rate, (3) complications, and (4) mortality. Methods Published literature was searched in the PubMed, EMBASE, and Cochrane Library databases. All of the included studies met the inclusion criteria. The primary outcomes were TTS and LOS. The secondary outcomes included the 30-day readmission rate, overall complication rate, specific complication rate (delirium and urinary tract infection), and 30-day and 1-year mortality. Language was restricted to English. The data analysis was carried out by Review Manager 5.3. Results A total of 7 published studies (9869 patients) were finally included, and these were all cohort studies. The meta-analysis showed that the TTS, LOS, and overall complication rate were significantly reduced in the ERAS group compared with the control group (p < 0.01). Moreover, no significant change was found in the 30-day readmission rate or 30-day and 1-year mortality. Conclusions ERAS significantly decreases the TTS, LOS, and complication rate without increasing readmission rate and mortality, which adds to the evidence that the implementation of ERAS is beneficial to patients undergoing hip fracture repair surgeries.

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Effectiveness of exercise training after bariatric surgery-a systematic literature review and meta-analysis

Obesity Reviews ◽

10.1111/obr.12740 ◽

2018 ◽

Vol 19 (11) ◽

pp. 1544-1556 ◽

Cited By ~ 19

Author(s):

A. Bellicha ◽

C. Ciangura ◽

C. Poitou ◽

P. Portero ◽

J.- M. Oppert

Keyword(s):

Bariatric Surgery ◽

Exercise Training ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis

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The capability of plasma osteoprotegerin as a predictor of cardiovascular disease: a systematic literature review

Acta Endocrinologica ◽

10.1530/eje-08-0554 ◽

2008 ◽

Vol 159 (5) ◽

pp. 603-608 ◽

Cited By ~ 60

Author(s):

Mads Nybo ◽

Lars M Rasmussen

Keyword(s):

Cardiovascular Disease ◽

High Risk ◽

Literature Review ◽

Systematic Literature Review ◽

Strong Predictor ◽

Meta Analysis ◽

High Plasma ◽

Cochrane Library ◽

Prognostic Information ◽

High Risk Populations

ObjectiveOsteoprotegerin (OPG) strongly inhibits bone resorption and may also serve as a vascular calcification inhibitor. However, recent studies have indicated that high plasma OPG is a strong predictor of cardiovascular disease (CVD) and mortality. To evaluate this capability, the data concerning OPG as a CVD predictor was gathered through a systematic literature review.Design and methodsStudies investigating OPG as a predictor of CVD or mortality were extracted from Medline and the Cochrane Library, retrieving 187 articles. Non-relevant articles were excluded, resulting in a total of 45 articles. After thorough evaluation of the abstracts, only eight prospective studies containing a follow-up period with a clinical emphasis on CVD were eligible for the literature review.ResultsAll studies except one confirmed that OPG measurement adds important prognostic information to the existing markers of CVD and mortality in high-risk populations. Hazard ratios emphasized the significant correlation between plasma OPG concentration and mortality. Due to methodological problems (e.g., population investigated, measurement principle, and statistics performed), meta-analysis could not be performed. As only one study was conducted in a healthy cohort, the results cannot per se be extrapolated to the general population.ConclusionThe combined results support plasma OPG as an independent predictor of CVD and mortality in high-risk populations. However, more longitudinal studies in general cohorts are needed before the use of plasma OPG can be evaluated in this regard.

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Performance of machine learning algorithms for glioma segmentation of brain MRI: a systematic literature review and meta-analysis

European Radiology ◽

10.1007/s00330-021-08035-0 ◽

2021 ◽

Author(s):

Evi J. van Kempen ◽

Max Post ◽

Manoj Mannil ◽

Richard L. Witkam ◽

Mark ter Laan ◽

...

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Machine Learning Algorithms ◽

Low Grade ◽

Automated Segmentation ◽

High Grade ◽

Low Grade Gliomas ◽

Quality Guidelines ◽

External Test

Abstract Objectives Different machine learning algorithms (MLAs) for automated segmentation of gliomas have been reported in the literature. Automated segmentation of different tumor characteristics can be of added value for the diagnostic work-up and treatment planning. The purpose of this study was to provide an overview and meta-analysis of different MLA methods. Methods A systematic literature review and meta-analysis was performed on the eligible studies describing the segmentation of gliomas. Meta-analysis of the performance was conducted on the reported dice similarity coefficient (DSC) score of both the aggregated results as two subgroups (i.e., high-grade and low-grade gliomas). This study was registered in PROSPERO prior to initiation (CRD42020191033). Results After the literature search (n = 734), 42 studies were included in the systematic literature review. Ten studies were eligible for inclusion in the meta-analysis. Overall, the MLAs from the included studies showed an overall DSC score of 0.84 (95% CI: 0.82–0.86). In addition, a DSC score of 0.83 (95% CI: 0.80–0.87) and 0.82 (95% CI: 0.78–0.87) was observed for the automated glioma segmentation of the high-grade and low-grade gliomas, respectively. However, heterogeneity was considerably high between included studies, and publication bias was observed. Conclusion MLAs facilitating automated segmentation of gliomas show good accuracy, which is promising for future implementation in neuroradiology. However, before actual implementation, a few hurdles are yet to be overcome. It is crucial that quality guidelines are followed when reporting on MLAs, which includes validation on an external test set. Key Points • MLAs from the included studies showed an overall DSC score of 0.84 (95% CI: 0.82–0.86), indicating a good performance. • MLA performance was comparable when comparing the segmentation results of the high-grade gliomas and the low-grade gliomas. • For future studies using MLAs, it is crucial that quality guidelines are followed when reporting on MLAs, which includes validation on an external test set.

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