scholarly journals Eight Surgical Interventions for Lumbar Disc Herniation: A Network Meta-Analysis on Complications

2021 ◽  
Vol 8 ◽  
Author(s):  
Fei-Long Wei ◽  
Tian Li ◽  
Quan-You Gao ◽  
Yi Yang ◽  
Hao-Ran Gao ◽  
...  
Keyword(s):  
Blood Loss ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Operation Time ◽  
Lumbar Discectomy ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Complication Rates ◽  
Surgical Interventions ◽  
Operative Complication

Objective: Therapeutic options for lumbar disc surgery (LDH) have been rapidly evolved worldwide. Conventional pair meta-analysis has shown inconsistent results of the safety of different surgical interventions for LDH. A network pooling evaluation of randomized controlled trials (RCT) was conducted to compare eight surgical interventions on complications for patients with LDH.Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for RCT from inception to June 2020, with registration in PROSPERO (CRD42020176821). This study is conducted in accordance with Cochrane guidelines. Primary outcomes include intraoperative, post-operative, and overall complications, reoperation, operation time, and blood loss.Results: A total of 27 RCT with 2,948 participants and eight interventions, including automated percutaneous lumbar discectomy (APLD), chemonucleolysis (CN), microdiscectomy (MD), micro-endoscopic discectomy (MED), open discectomy (OD), percutaneous endoscopic lumbar discectomy (PELD), percutaneous laser disc decompression (PLDD), and tubular discectomy (TD) were enrolled. The pooling results suggested that PELD and PLDD are with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss.Conclusion: The results of this study provided evidence that PELD and PLDD were with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss.Systematic Review Registration: PROSPERO, identifier CRD42020176821.

scholarly journals Comparison of 7 Surgical Interventions for Lumbar Disc Herniation: A Network Meta-analysis

2017 ◽  
Vol 6 (20;6) ◽  
pp. E863-E871
Author(s):  
Lin Cai
Keyword(s):  
Success Rate ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Complication Rate ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Reoperation Rate ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Surgical Interventions

Background: The number of interventions on intervertebral discs rapidly increased and the treatment options for lumbar disc surgery quickly evolved. It is important that the safety and efficacy of all new innovative procedures be compared with currently accepted forms of treatment; however, the previous pairwise meta-analyses could not develop the hierarchy of these treatments. Objectives: The purpose of the study is to perform a network meta-analysis to evaluate the clinical results of 7 surgical interventions for the treatment of lumbar disc herniation. Study Design: Network meta-analysis of randomized controlled trials (RCTs) for multiple treatment comparisons of lumbar disc herniation. Methods: We performed a Bayesian-framework network meta-analysis of RCTs to compare 7 surgical interventions for people with lumbar disc herniation. The eligible RCTs were identified by searching Embase, Pubmed, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google scholar. Data from 3 outcomes (success, complications, and reoperation rate) were independently extracted by 2 authors. Results: A total of 29 RCTs including 3,146 participants were finally included into this article. Our meta-analysis provides hierarchies of these 7 interventions. For the success rate the rank probability (from best to worst): percutaneous endoscopic lumber discectomy (PELD) > standard open discectomy (SOD) > standard open microsurgical discectomy (SOMD) > chemonucleolysis (CN) > microendoscopic discectomy (MED) > percutaneous laser disc decompression (PLDD) > automated percutaneous lumber discectomy (APLD). For the complication rate the rank probability (from best to worst): PELD > SOMD > SOD > MED > PLDD > CN > APLD. For the reoperation rate the rank probability (from best to worst): SOMD > SOD > MED > PLDD > PELD > CN > APLD. Limitations: The limitations of this network meta-analysis include the range of study populations and inconformity of the follow-up times and outcome measurements. Conclusions: This meta-analysis provides evidence that PELD might be the best choice to increase the success rate and decrease the complication rate, moreover SOMD might be the best option to drop the reoperation rate. APLD might lead to the lowest success rate and the highest complication and reoperation rate. Higher quality RCTs and direct head to head trials are needed to confirm these results.

scholarly journals Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
pp. 219256822110164
Author(s):  
Elsayed Said ◽  
Mohamed E. Abdel-Wanis ◽  
Mohamed Ameen ◽  
Ali A. Sayed ◽  
Khaled H. Mosallam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Interbody Fusion ◽  
Revision Rate ◽  
Meta Analysis ◽  
Posterior Lumbar Interbody Fusion ◽  
Operation Time ◽  
Controlled Trials ◽  
Lumbar Interbody Fusion ◽  
Randomized Controlled

Study Design: Systematic review and meta-analysis. Objectives: Arthrodesis has been a valid treatment option for spinal diseases, including spondylolisthesis and lumbar spinal stenosis. Posterolateral and posterior lumbar interbody fusion are amongst the most used fusion techniques. Previous reports comparing both methods have been contradictory. Thus, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to establish substantial evidence on which fusion method would achieve better outcomes. Methods: Major databases including PubMed, Embase, Web of Science and CENTRAL were searched to identify studies comparing outcomes of interest between posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF). We extracted data on clinical outcome, complication rate, revision rate, fusion rate, operation time, and blood loss. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome and the odds ratio with 95% confidence intervals (CIs) for binary outcomes. P < 0.05 was considered significant. Results: We retrieved 8 studies meeting our inclusion criteria, with a total of 616 patients (308 PLF, 308 PLIF). The results of our analysis revealed that patients who underwent PLIF had significantly higher fusion rates. No statistically significant difference was identified in terms of clinical outcomes, complication rates, revision rates, operation time or blood loss. Conclusions: This systematic review and meta-analysis provide a comparison between PLF and PLIF based on RCTs. Although PLIF had higher fusion rates, both fusion methods achieve similar clinical outcomes with equal complication rate, revision rate, operation time and blood loss at 1-year minimum follow-up.

scholarly journals Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

2020 ◽  
Author(s):  
lyu yunxiao ◽  
Bin Wang ◽  
Yunxiao Cheng ◽  
Yueming Xu ◽  
WeiBing Du
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Meta Analysis ◽  
Operation Time ◽  
Bile Leakage ◽  
Reoperation Rate ◽  
Postoperative Pancreatic Fistula ◽  
Controlled Trials ◽  
Cochrane Central Register

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy.Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that reoperation rates following isolated pancreaticojejunostomy were lower reoperation than with conventional pancreaticojejunostomy (OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage, reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy.Conclusions This study showed that isolated pancreaticojejunostomy was associated with a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

scholarly journals Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis

2015 ◽  
Vol 39 (4) ◽  
pp. E12 ◽  
Author(s):  
Oluwaseun O. Akinduro ◽  
Brandon A. Miller ◽  
Diogo C. Haussen ◽  
Gustavo Pradilla ◽  
Faiz U. Ahmad
Keyword(s):  
Surgical Complications ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Lumbar Discectomy ◽  
Complication Rates ◽  
Steroid Use ◽  
Central Registry ◽  
Epidural Steroid ◽  
Epidural Steroids ◽  
And Control

OBJECT The authors’ aim in this paper was to review the intraoperative use of epidural steroids in lumbar discectomy surgery with a focus on surgical complications. METHODS A comprehensive literature search was done using PubMed, MEDLINE, and the Cochrane Central Registry of Controlled Trials. Relevant papers were retrieved and analyzed. The authors performed a meta-analysis of all available data. Search terms included epidural, steroids, discectomy, lumbar disc surgery, herniated lumbar disc, methylprednisolone, and perioperative.The primary outcome was surgical complications such as wound infection or need for reoperation. Secondary outcomes were pain and postoperative narcotic usage. RESULTS Sixteen trials and 1 retrospective study (a total of 1933 patients) were eligible for inclusion in this study. In all studies, steroids were added epidurally over the nerve root before closure in cases, and control patients underwent discectomy alone. The mean age (42.7 years vs 42.4 years; RR 0.30 [95% CI −0.30 to 0.90], p = 0.32), overall complication rates (2.69% vs 1.18%; RR 1.94 [95% CI 0.72–5.26], p = 0.19), and infectious complication rates (0.94% vs 0.08%; RR 4.58 [95% CI 0.75–27.95], p = 0.10) were similar between the steroid group and control group, respectively. CONCLUSIONS There is good evidence that epidural steroids can decrease pain in the short term and decrease the usage of postoperative narcotics after lumbar spinal surgery for degenerative spinal disease. The authors’ results demonstrate a trend toward increased infection with epidural steroid use, but there was not a statistically significant difference. More studies are needed to validate the long-term risk/benefit ratio of epidural steroids in lumbar discectomy.

scholarly journals Efficacy and Safety of Bevacizumab in the Treatment of Pterygium: An Updated Meta-Analysis of Randomized Controlled Trials

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Yi Sun ◽  
Bowen Zhang ◽  
Xiuhua Jia ◽  
Shiqi Ling ◽  
Juan Deng
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Complication Rates ◽  
Efficacy And Safety ◽  
Conjunctival Autograft ◽  
Randomized Controlled ◽  
Significant Difference

Purpose. Studies investigating efficacy and safety of bevacizumab in pterygium have increased and reported controversial results. Thus, we updated this meta-analysis to clarify the issue. Methods. Studies were selected through search of the databases Embase, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from their inception up until June 2017. The pooled risk ratio (RR) and 95% confidence interval (CI) were calculated for recurrence and complication rates by using random effects model. Results. 1045 eyes in 18 randomized controlled trials (RCTs) enrolled. Overall, the pooled estimate showed a statistically significant effect of bevacizumab on the reduction of recurrence (RR 0.74, 95% CI 0.56–0.97, P=0.03). Subgroup analyses presented significant results beneficial to bevacizumab (primary pterygium group, RR 0.53, 95% CI 0.33–0.83, P=0.006; conjunctival autograft group, RR 0.48, 95% CI 0.25–0.91, P=0.02; and follow-up longer than 12 months group, RR 0.36, 95% CI 0.13–0.99, P=0.05). No statistically significant difference was observed in complication rates. Conclusions. Application of bevacizumab showed a statistically significant decrease in recurrence rate following removal of primary pterygia, or in cases with conjunctival autograft, or with follow-up longer than 12 months, while complications were not increased.

scholarly journals Percutaneous Compression Plate versus Dynamic Hip Screw for Treatment of Intertrochanteric Hip Fractures: A Meta-Analyse of Five Randomized Controlled Trials

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Lei Zhang ◽  
Jie Shen ◽  
Shengpeng Yu ◽  
Qiang Huang ◽  
Zhao Xie
Keyword(s):  
Blood Loss ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Operation Time ◽  
Dynamic Hip Screw ◽  
Plate Versus ◽  
Controlled Trials ◽  
Intertrochanteric Fractures ◽  
Randomized Controlled ◽  
Hip Screw

Background. Percutaneous compression plating (PCCP) has been advocated to reduce blood loss, relieve pain, and lead to faster rehabilitation for the treatment of intertrochanteric fractures. The purpose of this meta-analysis was to estimate the outcomes and complications of the PCCP versus dynamic hip screw (DHS) fixation for intertrochanteric fractures.Methods. All randomized controlled trials (RCT) that compared PCCP with DHS in treating adult patients with intertrochanteric fractures were included. Main outcomes were collected and analysed using the RevMan 5.1 version.Results. Five trials met the inclusion criteria. Compared with DHS, PCCP had similar operation time (95% CI: −26.01~4.05,P= 0.15), length of hospitalization (95% CI: −1.79~1.25,P= 0.73), mortality (95% CI: 0.37~1.02,P= 0.06), incidence of implant-related complications (95% CI: 0.29~1.82,P= 0.49), and reoperation rate (95% CI: 0.41~3.05,P= 0.83). But blood loss (95% CI: −173.84~−4.81,P= 0.04) and transfusion need (95% CI: −0.53~−0.07,P= 0.01) significantly favored the PCCP.Conclusions. The PCCP was associated with reduced blood loss and less transfusion need, but similar to DHS in other respects. Owing to the limitations of this systematic review, more high-quality RCTs are still needed to assess the clinical efficiency of PCCP.

Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis

2019 ◽  
Vol 68 (03) ◽  
pp. 212-218
Author(s):  
Louay M. Habbab ◽  
Lloyd Semelhago ◽  
André Lamy
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Complication Rates ◽  
Randomized Controlled ◽  
Transfusion Requirements

Abstract Background This meta-analysis was conducted to investigate the evidence for the efficacy and safety of intrapericardial tranexamic acid (TXA) in cardiac surgery. Methods We searched MEDLINE from 2000 to 2017 for randomized controlled trials that compared intrapericardial TXA to placebo. We performed a meta-analysis for the eligible trials that focused on chest tube drainage measured during the first 24 hours after surgery as a primary outcome. We also examined the secondary outcome measures of these trials such as the incidence of transfusion requirements following surgery and the evidence for any increase in complication rates. Results A total of seven randomized controlled trials (six on-pump and one off-pump) comparing topical application of TXA to placebo in 692 patients were eligible for the blood loss outcome data. These trials randomized 372 patients to receive TXA and 320 patients as controls. The use of intrapericardial TXA was associated with a considerable reduction in 24-hour blood loss in all seven studies and a weighted mean difference of −343.56 mL (95% confidence interval: −316.41, −370.72) significantly differed from zero (p = 0.005) with a heterogeneity of I 2 = 0%. The incidence of packed RBC transfusion in TXA patients was significantly lower in one study and was not significant but with trend in favor of TXA in five out of the six studies in which it was reported. In one trial, TXA was not detected in any patient and in another the studied groups were similar in postoperative complications, such as graft patency, myocardial infarction, cerebral infarction, atrial fibrillation, seizures, and infections. Conclusions Findings from this meta-analysis suggest that intrapericardial use of TXA in patients undergoing cardiac surgery can decrease postoperative bleeding without increasing the risk of postoperative seizures. Future large randomized, double-blind, controlled clinical trials are needed to confirm these promising findings.

scholarly journals Acupuncture for blepharospasm: a systematic review and meta-analysis protocol

2021 ◽  
Author(s):  
Hui HUANG ◽  
Qun Huang ◽  
Na Gao ◽  
Haoran Li ◽  
Weiwen Zou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Systematic Evaluation ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Eyelid Closure ◽  
Surgical Interventions ◽  
Oral Medications ◽  
Randomised Controlled

Abstract Background Blepharospasm is a disorder inducing bilateral eyelid closure due to irregular muscle contraction. Oral medications or surgical interventions currently still hardly achieve a great therapeutic effect. Acupuncture is indicated effective in improving blepharospasm, but its efficacy has not been comprehensively elucidated as a therapy, so a systematic evaluation on acupuncture for blepharospasm is desirable. Methods All randomised controlled trials related to acupuncture for blepharospasm will be screened from 9 databases, including 5 English databases (Cochrane Central Register of Controlled Trials, Web of Science, PubMed, MEDLINE, Excerpta Medica Database) and 4 Chinese databases (CNKI, Chinese Biomedical Literature Database, China Wanfang Database, and VIP Database). The primary outcomes include degree of blepharospasm, scores of BFM, UDRS, JRC, BSS, BDS, and BSDI. The incidence of adverse events will be also considered. Two reviewers will screen studies, extract data and assess the quality. Review Manager software 5.4.1 (provided by Cochrane, London, United Kingdom) will be used to assess risk of bias and synthesize data synthesis. Discussion Our study will investigate the efficacy and safety of acupuncture in treating blepharospasm, providing a summary to contribute to application of acupuncture. Systematic review registration: CRD42020222489, registered on Dec 24, 2020.

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