Effectiveness and safety of nasogastric decompression after elective surgery for colon and rectum neoplasms: a meta-analysis

For perioperative mechanical ventilation under general anesthesia, modern respirators aim at combining the benefits of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in modes typically named “volume-guaranteed” or “volume-targeted” pressure-controlled ventilation (PCV-VG). This systematic review and meta-analysis tested the hypothesis that PCV-VG modes of ventilation could be beneficial in terms of improved airway pressures (Ppeak, Pplateau, Pmean), dynamic compliance (Cdyn), or arterial blood gases (PaO2, PaCO2) in adults undergoing elective surgery under general anesthesia. Three major medical electronic databases were searched with predefined search strategies and publications were systematically evaluated according to the Cochrane Review Methods. Continuous variables were tested for mean differences using the inverse variance method and 95% confidence intervals (CI) were calculated. Based on the assumption that intervention effects across studies were not identical, a random effects model was chosen. Assessment for heterogeneity was performed with the χ2 test and the I2 statistic. As primary endpoints, Ppeak, Pplateau, Pmean, Cdyn, PaO2, and PaCO2 were evaluated. Of the 725 publications identified, 17 finally met eligibility criteria, with a total of 929 patients recruited. Under supine two-lung ventilation, PCV-VG resulted in significantly reduced Ppeak (15 studies) and Pplateau (9 studies) as well as higher Cdyn (9 studies), compared with VCV [random effects models; Ppeak: CI −3.26 to −1.47; p < 0.001; I2 = 82%; Pplateau: −3.12 to −0.12; p = 0.03; I2 = 90%; Cdyn: CI 3.42 to 8.65; p < 0.001; I2 = 90%]. For one-lung ventilation (8 studies), PCV-VG allowed for significantly lower Ppeak and higher PaO2 compared with VCV. In Trendelenburg position (5 studies), this effect was significant for Ppeak only. This systematic review and meta-analysis demonstrates that volume-targeting, pressure-controlled ventilation modes may provide benefits with respect to the improved airway dynamics in two- and one-lung ventilation, and improved oxygenation in one-lung ventilation in adults undergoing elective surgery.

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Effectiveness of iron supplementation with or without erythropoiesis-stimulating agents on red blood cell utilization in patients with preoperative anaemia undergoing elective surgery: a systematic review and meta-analysis

Transfusion Medicine Reviews ◽

10.1016/j.tmrv.2021.03.004 ◽

2021 ◽

Author(s):

Hans Van Remoortel ◽

Jorien Laermans ◽

Bert Avau ◽

Geertruida Bekkering ◽

Jørgen Georgsen ◽

...

Keyword(s):

Systematic Review ◽

Blood Cell ◽

Red Blood Cell ◽

Iron Supplementation ◽

Elective Surgery ◽

Meta Analysis ◽

Erythropoiesis Stimulating Agents ◽

Preoperative Anaemia

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Effects of non-steroidal anti-inflammatory drugs on cancer sites other than the colon and rectum: a meta-analysis

BMC Cancer ◽

10.1186/1471-2407-3-28 ◽

2003 ◽

Vol 3 (1) ◽

Cited By ~ 115

Author(s):

Antonio González-Pérez ◽

Luis A García Rodríguez ◽

Ruy López-Ridaura

Keyword(s):

Meta Analysis ◽

Colon And Rectum ◽

Inflammatory Drugs ◽

Anti Inflammatory

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Modulation of post-operative insulin resistance by pre-operative carbohydrate loading

Proceedings of The Nutrition Society ◽

10.1079/pns2002168 ◽

2002 ◽

Vol 61 (3) ◽

pp. 329-336 ◽

Cited By ~ 112

Author(s):

Olle Ljungqvist ◽

Jonas Nygren ◽

Anders Thorell

Keyword(s):

Insulin Resistance ◽

Heart Surgery ◽

Surgical Stress ◽

Elective Surgery ◽

Meta Analysis ◽

Open Heart Surgery ◽

Length Of Hospital Stay ◽

Cardiac Complications ◽

Intravenous Glucose ◽

Mortality And Morbidity

Insulin resistance develops as a response to virtually all types of surgical stress. There is an increasing body of evidence that suggests that insulin resistance in surgical stress is not beneficial for outcome. A recent large study in intensive-care patients showed that aggressive treatment of insulin resistance using intravenous insulin reduced mortality and morbidity substantially. Similarly, in burn patients, intensive insulin and glucose treatment has been shown to improve N economy and enhance skin-graft healing. In surgical patients insulin resistance has been characterized in some detail, and has been shown to have many similarities with metabolic changes seen in patients with type 2 diabetes. This finding may be important since insulin resistance has been shown to be one independent factor that influences length of stay. When patients about to undergo elective surgery have been treated with glucose intravenously or a carbohydrate-rich drink instead of overnight fasting, insulin resistance was reduced by about half. A small meta-analysis showed that when post-operative insulin resistance was reduced by preoperative carbohydrates, length of hospital stay was shortened. Overnight intravenous glucose at high doses improved post-operative N economy. This type of treatment has also been shown repeatedly to reduce cardiac complications after open-heart surgery. Furthermore, if the carbohydrates are given as a drink pre-operatively, pre-operative thirst, hunger and anxiety are markedly reduced. In summary, preventing or treating insulin resistance in surgical stress influences outcome. Fasting overnight is not an optimal way to prepare patients for elective surgery. Instead, pre-operative carbohydrates have clinical benefits.

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What is the effect of perioperative intravenous iron therapy in patients undergoing non-elective surgery? A systematic review with meta-analysis and trial sequential analysis

Perioperative Medicine ◽

10.1186/s13741-018-0109-4 ◽

2018 ◽

Vol 7 (1) ◽

Cited By ~ 5

Author(s):

Akshay Shah ◽

Antony J. R. Palmer ◽

Sheila A. Fisher ◽

Shah M. Rahman ◽

Susan Brunskill ◽

...

Keyword(s):

Systematic Review ◽

Sequential Analysis ◽

Elective Surgery ◽

Meta Analysis ◽

Intravenous Iron ◽

Iron Therapy ◽

Trial Sequential Analysis ◽

Intravenous Iron Therapy

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732 Delay to Elective Colorectal Cancer Surgery and its Potential Implications During the Covid-19 Pandemic: A Systematic Review and Metanalysis

British Journal of Surgery ◽

10.1093/bjs/znab259.817 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

T Whittaker ◽

M Abdelrazek ◽

A Fitzpatrick ◽

J Froud ◽

J Kelly ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Elective Surgery ◽

Meta Analysis ◽

Disease Free Survival ◽

Colorectal Cancer Surgery ◽

Elective Resection ◽

Hazard Ratios ◽

Patient Groups ◽

Number Needed To Harm

Abstract Aim The ongoing Covid-19 pandemic has interrupted the surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS). Method A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Metanalyses of the outcome’s OS and DFS were conducted. Forest plots, funnel plots, and tests of heterogeneity were produced. An estimated Number Needed to Harm (NNH) was calculated for statistically significant pooled Hazard Ratios (HRs). Results Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the pooled HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on meta-analysis. Conclusions This review recommends that elective surgery for CRC patients is not postponed, as evidence suggests delays from diagnosis are associated with poorer outcomes. Focused research is essential so that patient groups can be prioritized based on risk factors for future pandemics.

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Incidence of Venous Thromboembolism in Orthopaedic Foot and Ankle Surgeries

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00108 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0010

Author(s):

Ashish Shah ◽

Samuel Huntley ◽

Harshadkumar Patel ◽

Eildar Abyar ◽

Eva Lehtonen ◽

...

Keyword(s):

Venous Thromboembolism ◽

Elective Surgery ◽

Meta Analysis ◽

Categorical Variables ◽

Continuous Variables ◽

Foot And Ankle ◽

Improvement Program ◽

Female Sex ◽

Increased Risk ◽

Ankle Surgery

Category: Other Introduction/Purpose: Venous thromboembolism (VTE) is a rare but potentially lethal complication following orthopaedic foot and ankle surgery. Surgeons continue to debate the types of patients and procedures in which it is appropriate to use chemical thromboprophylaxis. A recent meta-analysis concluded that patients at high risk for VTE after foot and ankle surgery should receive prophylaxis, but there remains a paucity of data to elucidate which demographic or comorbidity variables are most strongly associated with development of VTE. The incidence of VTE after orthopaedic foot and ankle surgery stratified by specific procedure has yet to be examined. The purpose of this study is to report the incidence of and identify risk factors for VTE in a large sample of patients receiving orthopaedic foot and ankle surgery. Methods: In this study, we retrospectively analyzed prospectively-collected data from the National Surgical Quality Improvement Program (NSQIP) 2006 to 2015 data files. The incidence of VTE was calculated for 30 specific orthopaedic foot and ankle surgeries and for four broad types of foot and ankle surgery. A total of 23,212 patients were identified and grouped by current procedures terminology (CPT) codes. Demographic, comorbidity, and complication variables were analyzed to determine associations with development of VTE. Pearson’s chi-squared test was used to compare categorical variables and Student t test was used to compare continuous variables. P-values of p<0.05 were considered statistically significant. Multivariable modelling was not possible due to the very low number of VTE cases relative to non-VTE cases. Results: The mean age at the time of surgery was 52.7±17.8 years. VTE events were documented 142 times in our sample, yielding an overall sample VTE incidence of 0.6%. The types of procedures with the highest frequency of VTE were ankle fractures (105/15,302 cases, 0.7%), foot pathologies (28/5,466, 0.6%), and arthroscopy (2/398, 0.5%). Female sex, increasing age, obesity level, inpatient status, and non-elective surgery were all significantly associated with VTE events. Postoperative pneumonia was significantly associated with VTE development. Patients who developed a VTE stayed at the hospital after surgery significantly longer than patients without VTE (6.2 vs. 3.1 days). Patients who developed VTE also had significantly higher estimated probability of morbidity (8.0% vs. 6.0%) and mortality (2.0% vs. 1.0%) when compared to patients without VTE. Conclusion: The present study confirms that VTE events after foot and ankle procedures are rare. The data presented suggest that female sex, increasing age, higher BMI, inpatient status, and non-elective procedures are associated with increased risk for VTE after orthopaedic foot and ankle surgery. Prospective, randomized, controlled trials are necessary to definitively determine the efficacy of chemoprophylaxis and to develop evidence-based clinical practice guidelines to minimize VTE after foot and ankle procedures.

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