scholarly journals Timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis- A systematic review and meta-analysis

2021 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel
Keyword(s):  
Biliary Tract ◽  
Risk Ratio ◽  
Injury Risk ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Final Analysis ◽  
Complication Rates ◽  
Percutaneous Cholecystostomy ◽  
Prisma Statement ◽  
Timing Of Cholecystectomy

Abstract Introduction: This meta-analysis aimed to evaluate outcomes of early versus late cholecystectomy after percutaneous cholecystostomy.Methods:The study was conducted according to the PRISMA statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used.Results: Six studies including 18640 patients were included in the final analysis. There was no difference in overall complications within or after 72 hours cholecystectomy group, but mortality and biliary complications were significantly high in the less than 72 hours group (p=0.05 and 0.0002 respectively). There was no difference in mortality, overall complication, biliary tract complications in less than 1 week versus more than 1 week and less than 10 days versus more than 10 days group. Overall complications were significantly less in the less than 2 weeks group compared to the more than 2 weeks group. There was no difference in mortality and biliary tract complications between less than 2 weeks and more than 2 weeks group. Overall complication rate (risk ratio 0.67, p <0.0001), postoperative mortality (risk ratio 0.46, p=0.003), bile duct injury (risk ratio 0.62, p=0.01) was significantly less in earlier than 4-week group. Hospital stay was not significantly different between less than 4 weeks versus more than 4 weeks group. (Mean difference= -2.74, p=0.12). Ove all complication rates were significantly more in less than 8 weeks group. (Risk ratio 1.07, p=0.01).Conclusion:Early cholecystectomy preferably within 4 weeks after percutaneous cholecystostomy is preferable.

scholarly journals Timing of cholecystectomy after percutaneous cholecystectomy for acute cholecystitis- A systematic review and meta-analysis

2021 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel
Keyword(s):  
Systematic Review ◽  
Hospital Stay ◽  
Biliary Tract ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Mean Difference ◽  
Complication Rates ◽  
Percutaneous Cholecystostomy ◽  
Timing Of Cholecystectomy

Introduction: There is a controversy about the optimum timing of cholecystectomy after percutaneous cholecystostomy. This systematic review and meta-analysis aimed to evaluate outcomes of early versus late cholecystectomy after percutaneous cholecystectomy. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used. We evaluated cholecystectomy performed at different periods after percutaneous cholecystostomy within 72 hours or later, within or after one week or percutaneous cholecystostomy, within 10 days or after 10 days, less than 2 weeks or more than 2 weeks, less than 4 weeks or more than 4 weeks, less than 8 weeks or more than 8 weeks as per literature. Results: Six studies including 18640 patients were included in the final analysis. There was no difference in overall complications within or after 72 hours cholecystectomy group, but mortality and biliary complications were significantly high in the less than 72 hours group (p=0.05 and 0.0002 respectively). There was no difference in mortality, overall complication, biliary tract complications in less than 1 week versus more than 1 week and less than 10 days versus more than 10 days group. Overall complications were significantly less in the less than 2 weeks group compared to the more than 2 weeks group. There was no difference in mortality and biliary tract complications between less than 2 weeks and more than 2 weeks group. Overall complication rate (risk ratio 0.67, p <0.0001), postoperative mortality (risk ratio 0.46, p=0.003), bile duct injury (risk ratio 0.62, p=0.01) was significantly less in earlier than 4-week group. Hospital stay was not significantly different between less than 4 weeks versus more than 4 weeks group. (Mean difference= -2.74, p=0.12). Ove all complication rates were significantly more in less than 8 weeks group. (Risk ratio 1.07, p=0.01). Hospital stay was significantly less in less than 8 weeks group. (Mean difference 0.87, p=0.01). Conclusion: Early cholecystectomy preferably within 4 weeks after percutaneous cholecystostomy is preferable over late cholecystectomy.

scholarly journals Non-intubated thoracoscopic lobectomies for lung cancer: an exploratory systematic review and meta-analysis

2020 ◽  
Vol 31 (4) ◽  
pp. 499-506 ◽  
Author(s):  
Elena Prisciandaro ◽  
Luca Bertolaccini ◽  
Giulia Sedda ◽  
Lorenzo Spaggiari
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Complication Rates ◽  
Thoracoscopic Lobectomy ◽  
Retrospective Cohort Studies ◽  
The Individual

Abstract Our goal was to assess the safety, feasibility and oncological outcomes of non-intubated thoracoscopic lobectomies for non-small-cell lung cancer (NSCLC). A comprehensive search was performed in EMBASE (via Ovid), MEDLINE (via PubMed) and Cochrane CENTRAL from January 2004 to March 2020. Studies comparing non-intubated anaesthesia with intubated anaesthesia for thoracoscopic lobectomy for NSCLC were included. An exploratory systematic review and a meta-analysis were performed by combining the reported outcomes of the individual studies using a random effects model. For dichotomous outcomes, risk ratios were calculated and for continuous outcomes, the mean difference was used. Three retrospective cohort studies were included, with a total of 204 patients. The comparison between non-intubated and intubated patients undergoing thoracoscopic lobectomy showed no statistically significant differences in postoperative complication rates [risk ratio 0.65, 95% confidence interval (CI) 0.36–1.16; P = 0.30; I2 = 17%], operating times (mean difference −12.40, 95% CI −28.57 to 3.77; P = 0.15; I2 = 48%), length of hospital stay (mean difference −1.13, 95% CI −2.32 to 0.05; P = 0.90; I2 = 0%) and number of dissected lymph nodes (risk ratio 0.92, 95% CI 0.78–1.25; P = 0.46; I2 = 0%). Despite the limitation of only 3 papers included, awake and intubated thoracoscopic lobectomies for resectable NSCLC seem to have comparable perioperative and postoperative outcomes. Nevertheless, the oncological implications of the non-intubated approach should be considered. The long-term benefits for patients with lung cancer need to be carefully assessed.

scholarly journals Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes

2019 ◽  
Vol 53 (21) ◽  
pp. 1362-1370 ◽  
Author(s):  
Nicol van Dyk ◽  
Fearghal P Behan ◽  
Rod Whiteley
Keyword(s):  
Systematic Review ◽  
Injury Prevention ◽  
Risk Ratio ◽  
Injury Risk ◽  
Meta Analysis ◽  
Research Question ◽  
Age Groups ◽  
Eligibility Criteria ◽  
Hamstring Injuries ◽  
Prevention Programmes

Research questionDoes the Nordic hamstring exercise (NHE) prevent hamstring injuries when included as part of an injury prevention intervention?DesignSystematic review and meta-analysis.Eligibility criteria for selecting studiesWe considered the population to be any athletes participating in any sporting activity, the intervention to be the NHE, the comparison to be usual training or other prevention programmes, which did not include the NHE, and the outcome to be the incidence or rate of hamstring injuries.AnalysisThe effect of including the NHE in injury prevention programmes compared with controls on hamstring injuries was assessed in 15 studies that reported the incidence across different sports and age groups in both women and men.Data sourcesMEDLINE via PubMed, CINAHL via Ebsco, and OpenGrey.ResultsThere is a reduction in the overall injury risk ratio of 0.49 (95% CI 0.32 to 0.74, p=0.0008) in favour of programmes including the NHE. Secondary analyses when pooling the eight randomised control studies demonstrated a small increase in the overall injury risk ratio 0.52 (95% CI 0.32 to 0.85, p=0.0008), still in favour of the NHE. Additionally, when studies with a high risk of bias were removed (n=8), there is an increase of 0.06 in the risk ratio to 0.55 (95% CI 0.34 to 0.89, p=0.006).ConclusionsProgrammes that include the NHE reduce hamstring injuries by up to 51%. The NHE essentially halves the rate of hamstring injuries across multiple sports in different athletes.Trial registration numberPROSPERO CRD42018106150.

Scapular Dyskinesis Is Not an Isolated Risk Factor for Shoulder Injury in Athletes: A Systematic Review and Meta-analysis

2020 ◽  
pp. 036354652096850
Author(s):  
Campbell Hogan ◽  
Jo-Anne Corbett ◽  
Simon Ashton ◽  
Luke Perraton ◽  
Rachel Frame ◽  
...  
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Risk Ratio ◽  
Injury Risk ◽  
Meta Analysis ◽  
Significant Risk ◽  
Injury Rate ◽  
Scapular Dyskinesis ◽  
Shoulder Injuries ◽  
Shoulder Injury

Background: Scapular dyskinesis has been considered a risk factor for athletic shoulder injury; however, findings in the prospective literature have demonstrated mixed results. Purpose: To determine if scapular dyskinesis increases the risk of shoulder injury in athletes. Study Design: Meta-analysis. Methods: A systematic search was conducted on the MEDLINE, CINAHL Plus, SPORTDiscus, and Embase databases to identify prospective studies examining scapular dyskinesis and shoulder injury risk in athletes. Studies were included if they assessed participants using a dynamic scapular assessment at baseline and monitored for the development of shoulder injury. Data from the studies were subject to meta-analysis using the Mantel-Haenszel method to produce a pooled risk ratio. Results: Seven studies were eligible for inclusion, resulting in 212 shoulder injuries observed across 923 athletes. Scapular dyskinesis was present in 46% of participants, and these athletes had an injury rate of 25%. The presence of scapular dyskinesis displayed a trend to increase the risk of shoulder injury, but this was not statistically significant (risk ratio, 1.07; 95% CI, 0.85-1.34; P = .59). Conclusion: Scapular dyskinesis was not significantly associated with the development of shoulder injury in athletes. Registration: CRD42019133089 (PROSPERO).

scholarly journals Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis

2020 ◽  
pp. 145749692095783
Author(s):  
E. Ekman ◽  
K. Lehtimäki ◽  
J. Syvänen ◽  
M. Saltychev
Keyword(s):  
Confidence Interval ◽  
Risk Ratio ◽  
Intramedullary Nail ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Weight Bearing ◽  
Tibial Fractures ◽  
Controlled Trials ◽  
Complication Rates ◽  
Distal Tibial Fractures

Background and Aims: To evaluate evidence on the superiority of plate fixation over intramedullary nail fixation in the treatment of distal tibial fractures regarding functional outcomes and complication rates. Material and Methods: Cochrane Controlled Trials Register, Medline, Embase, CINAHL, Scopus, and Web of Science databases were searched in December 2019. The risk of systematic bias was assessed according to the Cochrane Collaboration’s domain-based evaluation framework. Results: The search resulted in 514 records, the final sample included 10 randomized controlled trials (782 patients). There were statistically significant differences in operating time (−11.2, 95% confidence interval: −16.3 to −6.1 min), time to partial weight bearing (−0.96, 95% confidence interval: −1.8 to −0.1 weeks), time to full weight bearing (−2.2, 95% confidence interval: −4.32 to −0.01 weeks), the rates of deep infections (risk ratio = 0.37, 95% confidence interval: 0.19 to 0.69), and the rates of soft-tissue complications (risk ratio = 0.52, 95% confidence interval: 0.33 to 0.82) favoring intramedullary nail. Intraoperative blood loss (127.2, 95% confidence interval: 34.7 to 219.7 mL) and postoperative knee pain and stiffness (relative risk = 5.6, 95% confidence interval: 1.4–22.6) showed significant differences favoring plate fixation. When combining all complication rates, the difference was risk ratio = 0.77 (95% confidence interval: 0.63 to 0.95) favoring intramedullary nail. No significant differences in radiation time, length of incision, length of hospital stay, time to return to work, time to union, the rates of healing complications or secondary procedures, ankle pain or stiffness, or functional scores were found. Conclusion: This meta-analysis suggests that intramedullary nail might be slightly superior in reducing postoperative complications and result in slightly faster healing when compared to plate fixation.

scholarly journals Efficacy of Endocuff Vision compared to first-generation Endocuff in adenoma detection rate and polyp detection rate in high-definition colonoscopy: a systematic review and network meta-analysis

2021 ◽  
Vol 09 (01) ◽  
pp. E41-E50
Author(s):  
Muhammad Aziz ◽  
Hossein Haghbin ◽  
Manesh Kumar Gangwani ◽  
Sachit Sharma ◽  
Yusuf Nawras ◽  
...  
Keyword(s):  
Systematic Review ◽  
Detection Rate ◽  
Meta Analysis ◽  
Final Analysis ◽  
Adenoma Detection Rate ◽  
Complication Rates ◽  
Polyp Detection ◽  
High Definition ◽  
Polyp Detection Rate ◽  
Adenoma Detection

Abstract Background and study aims Recently, the newer Endocuff Vision (ECV) has been evaluated for improving colonoscopy outcome metrics such as adenoma detection rate (ADR) and polyp detection rate (PDR). Due to lack of direct comparative studies between ECV and original Endocuff (ECU), we performed a systematic review and network meta-analysis to evaluate these outcomes. Methods The following databases were searched: PubMed, Embase, Cochrane, and Web of Sciences to include randomized controlled trials (RCTs) comparing ECV or ECU colonoscopy to high-definition (HD) colonoscopy. Direct as well as network meta-analyses comparing ADR and PDR were performed using a random effects model. Relative-risk (RR) with 95 % confidence interval (CI) was calculated. Results A total of 12 RCTs with 8638 patients were included in the final analysis. On direct meta-analysis, ECV did not demonstrate statistically improved ADR compared to HD colonoscopy (RR: 1.12, 95 % CI 0.99–1.27). A clinically and statistically improved PDR was noted for ECV compared to HD (RR: 1.15, 95 % CI 1.03–1.28) and ECU compared to HD (RR: 1.26, 95 % CI 1.09–1.46) as well as improved ADR (RR: 1.22, 95 % CI 1.05–1.43) was observed for ECU colonoscopy when compared to HD colonoscopy. These results were also consistent on network meta-analysis. Lower overall complication rates (RR: 0.14, 95 % CI 0.02–0.84) and particularly lacerations/erosions (RR: 0.11, 95 % CI 0.02–0.70) were noted with ECV compared to ECU colonoscopy. Conclusions Although safe, the newer ECV did not significantly improve ADR compared to ECU and HD colonoscopy. Further device modification is needed to increase the overall ADR and PDR.

scholarly journals Obesity as a Risk Factor for Failure to Wean from ECMO: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Syed Arsalan A. Zaidi ◽  
Kainat Saleem
Keyword(s):  
Risk Ratio ◽  
Meta Analysis ◽  
Survival Rates ◽  
Final Analysis ◽  
Total Sample ◽  
Sample Population ◽  
Obese Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Nonobese Patients

Purpose. Obesity has been associated with an increased risk of respiratory complications and other systemic illnesses. Respiratory dynamics in an obese patient, combined with modified lung physiology of ARDS, present a significant challenge in managing obese patients with ARDS. Many physicians think of obesity as a relative contraindication to ECMO. We performed a meta-analysis to see the effect of obesity on weaning from ECMO and survival to hospital discharge. Methods. We searched online databases for studies on ECMO and obesity. The search yielded 49 citations in total; after extensive review, six studies were assessed and qualified to be included in the final analysis. Patients were stratified into BMI >30 kg/m2 (obese) and BMI < 30 kg/m2 (nonobese). Results. In meta-analysis, there was a total sample population of 1285 patients, with 466 in the obese group and 819 in the nonobese group. There was no significant difference in weaning from ECMO when compared between obese and nonobese patients, with a risk ratio of 1.03 and 95% confidence interval (CI) of 0.94–1.13 (heterogeneity: chi2 = 7.44, df = 4 ( p = 0.11 ), I2 = 46%). There was no significant difference in survival rates between obese and nonobese patients who were treated with ECMO during hospitalization, with a risk ratio of 1.04 and 95% CI of 0.86–1.25 (heterogeneity: Tau2 0.03, chi2 = 14.61, df = 5 ( p = 0.01 ), I2 = 66%). Conclusion. Our findings show no significant difference in survival and weaning from ECMO in obese vs. nonobese patients. ECMO therapy should not be withheld from obese patients, as obesity is not a contraindication to ECMO.

scholarly journals Dyslipidaemia and mortality in COVID-19 patients - a meta-analysis

QJM ◽  
2021 ◽  
Author(s):  
Marco Zuin ◽  
Gianluca Rigatelli ◽  
Claudio Bilato ◽  
Carlo Cervellati ◽  
Giovanni Zuliani ◽  
...  
Keyword(s):  
Random Effects ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Random Effect ◽  
Final Analysis ◽  
Short Term ◽  
Random Effects Models ◽  
Pooled Prevalence ◽  
Statistical Heterogeneity ◽  
Trim And Fill

Abstract Objective The prevalence and prognostic implications of pre-existing dyslipidaemia in patients infected by the SARS-CoV-2 remain unclear. To perform a systematic review and meta-analysis of prevalence and mortality risk in COVID-19 patients with pre-existing dyslipidaemia. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to January 31, 2021, reporting data on dyslipidaemia among COVID-19 survivors and non-survivors. The pooled prevalence of dyslipidaemia was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic. Results Eighteen studies, enrolling 74.132 COVID-19 patients [mean age 70.6 years], met the inclusion criteria and were included in the final analysis. The pooled prevalence of dyslipidaemia was 17.5% of cases (95% CI: 12.3-24.3%, p &lt; 0.0001), with high heterogeneity (I2=98.7%). Pre-existing dyslipidaemia was significantly associated with higher risk of short-term death (OR: 1.69, 95% CI: 1.19-2.41, p = 0.003), with high heterogeneity (I2=88.7%). Due to publication bias, according to the Trim-and-Fill method, the corrected random-effect ORs resulted 1.61, 95% CI 1.13-2.28, p &lt; 0.0001 (one studies trimmed). Conclusions Dyslipidaemia represents a major comorbidity in about 18% of COVID-19 patients but it is associated with a 60% increase of short-term mortality risk.

The effects of centralizing cancer surgery on postoperative mortality: A systematic review and meta-analysis

2021 ◽  
pp. 135581962110089
Author(s):  
Roberto Grilli ◽  
Federica Violi ◽  
Maria Chiara Bassi ◽  
Massimiliano Marino
Keyword(s):  
Evaluation Studies ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Interrupted Time Series ◽  
High Volume ◽  
Cancer Surgery ◽  
Interrupted Time Series Analysis ◽  
Meta Regression ◽  
Meta Regression Analysis ◽  
After Cancer

Objectives To review the evidence of the effects of centralization of cancer surgery on postoperative mortality. Methods We searched Medline, Embase, Cinahl, Cochrane and Scopus (up to November 2019) for studies that (i) assessed the effects of centralization of cancer surgery policies on in-hospital or 30-day mortality, or (ii) described changes in both postoperative mortality for a surgical intervention and degree of centralization using reduction in the number of hospitals or increases in the proportion of patients undergoing cancer surgery at high volume hospitals as proxy. PRISMA guidelines were followed. We estimated pooled odds ratios (OR) and conducted meta-regression to assess the relationship between degree of centralization and mortality. Results A total of 41 studies met our inclusion criteria of which 15 evaluated the effect of centralization policies on postoperative mortality after cancer surgery and 26 described concurrent changes in the degree of centralization and postoperative mortality. Policy evaluation studies mainly used before-after designs (n = 13) or interrupted time series analysis (n = 2), mainly focusing on pancreatic, oesophageal and gastric cancer. All but one showed some degree of reduction in postoperative mortality, with statistically significant effects demonstrated by six studies. The pooled odds ratio for centralization policy effect was 0.68 (95% Confidence interval: 0.54–0.85; I2 = 80%). Meta-regression analysis of the 26 descriptive studies found that an increase of the proportion of patients treated at high volume hospitals was associated with greater reduction in postoperative mortality. Conclusions Centralization of cancer surgery is associated with reduced postoperative mortality. However, existing evidence tends to be of low quality and estimates of the effect size are likely inflated. There is a need for prospective studies using more robust approaches, and for centralization efforts to be accompanied by well-designed evaluations of their effectiveness.

Sign in / Sign up

Export Citation Format

Share Document