The surgical treatment of subaxial acute cervical spine facet dislocations in adults: a systematic review and meta-analysis

Neurosurgical Review - Adult cervical spine traumatic facet joint dislocations occur when excessive traumatic forces displace the vertebrae’s facets, leading to loss of joint congruence....     

Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis

BACKGROUND: Current guidelines recommend the use of a combination of inhaled beta(2) agonists and anticholinergics, particularly for patients with acute severe or life threatening asthma in the emergency setting. However, this statement is based on a relatively small number of randomised controlled trials and related systematic reviews. A review was undertaken to incorporate the more recent evidence available about the effectiveness of treatment with a combination of beta(2) agonists and anticholinergics compared with beta(2) agonists alone in the treatment of acute asthma. METHODS: A search was conducted of all randomised controlled trials published before April 2005. RESULTS: Data from 32 randomised controlled trials (n = 3611 subjects) showed significant reductions in hospital admissions in both children (RR = 0.73; 95% CI 0.63 to 0.85, p = 0.0001) and adults (RR = 0.68; 95% CI 0.53 to 0.86, p = 0.002) treated with inhaled anticholinergic agents. Combined treatment also produced a significant increase in spirometric parameters 60-120 minutes after the last treatment in both children (SMD = -0.54; 95% CI -0.28 to -0.81, p = 0.0001) and adults (SMD = -0.36; 95% CI -0.23 to -0.49, p = 0.00001). CONCLUSIONS: This review strongly suggests that the addition of multiple doses of inhaled ipratropium bromide to beta(2) agonists is indicated as the standard treatment in children, adolescents, and adults with moderate to severe exacerbations of asthma in the emergency setting.     

Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis

Introduction and hypothesis

The efficacy and safety of removing or preserving the uterus during reconstructive pelvic surgery is a matter of debate.

Methods

We performed a systematic review and meta-analysis of studies that compared hysteropreservation and hysterectomy in the management of uterine prolapse. PubMed, Medline, SciELO and LILACS databases were searched from inception until January 2017. We selected only randomized controlled trials and observational cohort prospective comparative studies. Primary outcomes were recurrence and reoperation rates. Secondary outcomes were: operative time, blood loss, visceral injury, voiding dysfunction, duration of catheterization, length of hospital stay, mesh exposure, dyspareunia, malignant neoplasia and quality of life.

Results

Eleven studies (six randomized and five non-randomized) were included involving 910 patients (462 in the hysteropreservation group and 448 in the hysterectomy group). Pooled data including all surgical techniques showed no difference between the groups regarding recurrence of uterine prolapse (RR 1.65, 95% CI 0.88–3.10; p = 0.12), but the risk of recurrence following hysterectomy was lower when the vaginal route was used with native tissue repair (RR 10.61; 95% CI 1.26–88.94; p = 0.03). Hysterectomy was associated with a lower reoperation rate for any prolapse compartment than hysteropreservation (RR 2.05; 95% CI 1.13–3.74; p = 0.02). Hysteropreservation was associated with a shorter operative time (mean difference ?12.43 min; 95% CI ?14.11 to ?10.74 ; p < 0.00001) and less blood loss (mean difference ?60.42 ml; 95% CI ?71.31 to ?49.53 ml; p < 0.00001). Other variables were similar between the groups.

Conclusions

Overall, the rate of recurrence of uterine prolapse was not lower but the rate of reoperation for prolapse was lower following hysterectomy, while operative time was shorter and blood loss was less with hysteropreservation. The limitations of this analysis were the inclusion of nonrandomized studies and the variety of surgical techniques. The results should be interpreted with caution due to potential biases.

     

The outcome of microvascular decompression for hemifacial spasm: a systematic review and meta-analysis

Microvascular decompression (MVD) is the first choice of surgery for hemifacial spasm (HFS). MVD surgery for vertebral artery (VA)-associated HFS is more difficult than for non-VA-associated HFS. There is controversy about the cure rate and complication of MVD for HFS in previous studies. We searched PubMed, Web of Science, and Embase for relevant publications. Based on the search results, we compared the outcomes of MVD for VA-associated HFS and non-VA-associated HFS. At the same time, we analyzed spasm-free rates and the complications and assessed the relationship between VA-associated HFS and gender, left side, and age. For analysis, six studies that included 2952 patients in the VA-associated group and 604 in the non-VA-associated group were selected. The effective rate of MVD was not significantly different between both groups (OR?=?1.16, 95% CI 0.81–1.67, P?=?0.42). Compared to non-VA-associated group, the transient complications (OR?=?0.64, 95% CI 0.46–0.89, P?=?0.008) and permanent complications (OR?=?0.28, 95% CI 0.15–0.54, P?=?0.0001) occurred more frequently in VA-associated group. The rate of hearing loss was significantly higher in VA-associated HFS than non-VA-associated HFS (OR?=?0.35, 95% CI 0.19–0.64, P?=?0.0007); the facial paralysis after operation was not significantly different between both groups (OR?=?1.25, 95% CI 0.91–1.72, P?=?0.17). There were older patients (WMD?=?3.67, 95% CI 3.29–4.05, P?<?0.00001) and more left-sided HFS (OR?=?0.23, 95% CI 0.19???0.29, P?<?0.0002) in the VA-associated HFS group than non-VA-associated HFS group, while the non-VA-associated HFS group was female-dominated (OR?=?1.58, 95% CI 1.32???1.89, P?<?0.00001). Both groups achieved good results in MVD cure rates. In VA-associated HFS, the complication rate of decompression and the rate of hearing loss after operation were higher than in non-VA-associated HFS, but the facial paralysis after operation was similar in both groups, and most complications were transient and disappeared during follow-up. VA-associated HFS is more prevalent in older adults, less prevalent in women, and more predominantly left-sided. More clinical studies are needed to better compare the efficacy and complication of MVD between both groups.

     

Intravesical treatment of painful bladder syndrome: a systematic review and meta-analysis

Introduction and hypothesis

The objective of the study was to assess the effectiveness of intravesical treatment for painful bladder syndrome (PBS).

Methods

A systematic review was performed until December 31, 2010. The selection criteria included only randomized controlled trials of PBS patients who received intravesical treatment. The primary outcomes measures were clinical and urodynamic parameters. Relative risk and mean differences were used for binary and continuous outcomes respectively, with confidence interval of 95%.

Results

The search strategy identified 770; however, only 28 eligible trials met methodological requirements for complete analysis. Altogether, the review included four treatment modalities: resiniferatoxin, Bacillus Calmette–Guérin (BCG), oxybutynin, and alkalinized lidocaine. Meta-analysis of BCG therapy showed improvement in symptoms according to the Wisconsin Interstitial Cystitis Symptom Inventory, but no difference in 24-h urinary frequency.

Conclusions

Meta-analysis showed an improvement exclusively of the symptoms as measured by the Wisconsin Interstitial Cystitis Inventory, but not in 24-h urinary frequency, with BCG therapy. Further randomized clinical trials, including trials of more recent drugs, are required for evaluation of intravesical therapies for PBS.     

Laser therapy in the treatment of melasma: a systematic review and meta-analysis

Lasers in Medical Science - Melasma is a highly prevalent and cosmetically disfiguring pigmented skin disease. The post-treatment results are often unsatisfactory. A large number of clinical trials...     

Association between antithrombotic drug use before chronic subdural haematoma and outcome after drainage: a systematic review and meta-analysis

In view of their age and vascular co-morbidities, people are often taking an antithrombotic drug when diagnosed with chronic subdural haematoma (CSDH). It is unclear whether antithrombotic use at CSDH diagnosis, or resumption afterwards, is associated with recurrent CSDH or vaso-occlusive events. We systematically reviewed the literature for studies reporting CSDH recurrence or vaso-occlusive events after drainage of CSDH associated with antithrombotic drug use. We searched Medline 1946–2016 and Embase 1974–2016 inclusive for cohort studies reporting the risk of CSDH recurrence or vaso-occlusive events after CSDH associated with antithrombotic (anticoagulant or antiplatelet) drug use. We meta-analysed outcome data using a random effect model and assessed inconsistency between studies using the I-squared (I ²) statistic. We found 20 studies reporting outcome after drainage of CSDH associated with antithrombotic drug use. Before CSDH drainage, 337 (11.5%) of 2941 patients in 12 studies used an anticoagulant drug and 600 (19%) of 3150 patients in 11 studies used an antiplatelet drug. The association between antithrombotic drug use and CSDH recurrence was significant for antiplatelet drug use (relative risk [RR] 1.36, 95% CI 1.05 to 1.75; I ² = 36.3%), but marginally significant for anticoagulant drug use (RR 1.38 95% CI 1.00–1.91; I ² = 37.5%). Two studies including 30 patients reported one vaso-occlusive outcome event after CSDH?. Antithrombotic drug use at CSDH diagnosis may be associated with post-operative CSDH recurrence. It is unclear whether this is attributable to confounding factors, antithrombotic reversal strategies or antithrombotic drug resumption. Further observational studies and randomised controlled trials of antithrombotic drug resumption are needed.     

Closed suction surgical wound drainage after hip fracture surgery: a systematic review and meta-analysis of randomised controlled trials

There is still debate over the use of drains following hip fracture surgery. We have performed a systematic review and meta-analysis of the literature for randomised trials that related to the use of closed suction drains following hip fracture surgery. Six studies involving 664 patients were identified. There was no statistically significant difference in the occurrence of wound healing complications, re-operations or requirement for blood transfusion between drained and un-drained wounds. All other outcomes reported failed to show any benefit from the use of drains. Further randomised trials are required and until they have been undertaken the efficacy of closed surgical drainage systems in hip fracture surgery is unknown.

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Résumé  Il existe toujours un débat sur l’utilisation de drains après traitement chirurgical d’une fracture de la hanche. Nous avons réalisé une méta analyse de la littérature à partir d’essais randomisés relatant l’usage de drains aspiratifs après fracture de la hanche opérée. Six études regroupant 664 patients ont été analysées. Il n’y a pas de différences significatives sur le taux de complications (hématome). Le nombre des réinterventions, ni la nécessité de transfusions entre les plaies drainées et non drainées. De nouveaux essais randomisés seront utiles pour déterminer l’efficacité du drainage chirurgical après fracture de la hanche.

     

Hypothermia treatment for traumatic brain injury: a systematic review and meta-analysis

In this study, we conducted an updated meta-analysis of the effects of hypothermia therapy on mortality, favorable neurologic outcome, and associated adverse effects in adults with traumatic brain injury (TBI) for use by Brain Trauma Foundation (BTF)/American Association of Neurological Surgeons (AANS) task force to develop evidence-based treatment guidelines. Our data sources relied on handsearches of four previous good-quality systematic reviews, which all conducted electronic searches of primarily MEDLINE (OVID), EMBASE, and Cochrane Library. An independent, supplemental electronic search of MEDLINE was undertaken as well (last searched June 2007). Only English-language publications of randomized controlled trials of therapeutic hypothermia in adults with TBI were selected for analysis. Two reviewers independently abstracted data on trial design, patient population, hypothermia and cointervention protocols, patient outcomes, and aspects of methodological quality. Pooled relative risks (RR) and associated 95% confidence intervals (CIs) were calculated for each outcome using random-effects models. In the current study, only 13 trials met eligibility criteria, with a total of 1339 randomized patients. Sensitivity analyses revealed that outcomes were influenced by variations in methodological quality. Consequently, main analyses were conducted based on eight trials that demonstrated the lowest potential for bias (n = 781). Reductions in risk of mortality were greatest (RR 0.51; 95% CI 0.33, 0.79) and favorable neurologic outcomes much more common (RR 1.91; 95% CI 1.28, 2.85) when hypothermia was maintained for more than 48 h. However, this evidence comes with the suggestion that the potential benefits of hypothermia may likely be offset by a significant increase in risk of pneumonia (RR 2.37; 95% CI 1.37, 4.10). In sum, the present study's updated meta-analysis supports previous findings that hypothermic therapy constitutes a beneficial treatment of TBI in specific circumstances. Accordingly, the BTF/AANS guidelines task force has issued a Level III recommendation for optional and cautious use of hypothermia for adults with TBI.     

Comparison of surgical outcomes in cystic and solid vestibular schwannomas: a systematic review and meta-analysis

Neurosurgical Review - Most studies reported that cystic vestibular schwannoma (CVS) surgery has a less favourable prognosis than solid vestibular schwannoma (SVS) surgery. However, some studies...     

Hospital readmission after pancreaticoduodenectomy: A systematic review and meta-analysis

Background

Appropriate postoperative readmission rates and modifiable risk factors for readmission have yet to be defined for many operations. This systematic review and meta-analysis attempt to define these parameters for pancreaticoduodenectomy.

Radiological follow-up after implanting cervical disc prosthesis in anterior discectomy: a systematic review

Objective

The objective of this study was to review current literature on the comparison of the radiological outcome of cervical arthroplasty with fusion after anterior discectomy for radiculopathy.

Delirium in neurosurgery: a systematic review and meta-analysis

Delirium is a frequent occurring complication in surgical patients. Nevertheless, a scientific work-up of the clinical relevance of delirium after intracranial surgery is lacking. We conducted a systematic review (CRD42020166656) to evaluate the current diagnostic work-up, incidence, risk factors and health outcomes of delirium in this population. Five databases (Embase, Medline, Web of Science, PsycINFO, Cochrane Central) were searched from inception through March 31st, 2021. Twenty-four studies (5589 patients) were included for qualitative analysis and twenty-one studies for quantitative analysis (5083 patients). Validated delirium screening tools were used in 70% of the studies, consisting of the Confusion Assessment Method (intensive care unit) (45%), Delirium Observation Screening Scale (5%), Intensive Care Delirium Screening Checklist (10%), Neelon and Champagne Confusion Scale (5%) and Nursing Delirium Screening Scale (5%). Incidence of post-operative delirium after intracranial surgery was 19%, ranging from 12 to 26% caused by variation in clinical features and delirium assessment methods. Meta-regression for age and gender did not show a correlation with delirium. We present an overview of risk factors and health outcomes associated with the onset of delirium. Our review highlights the need of future research on delirium in neurosurgery, which should focus on optimizing diagnosis and assessing prognostic significance and management.

     

Management of chest tubes after pulmonary resection: a systematic review and meta-analysis

Background

We performed a systematic review and meta-analysis to determine the effect of suction with water seal, compared with water seal alone, applied to intrapleural chest tubes on the duration of air leaks in patients undergoing pulmonary surgery.

Methods

We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to find randomized controlled trials (RCTs) comparing the effect of the 2 methods on the duration of air leaks. Trials were systematically assessed for eligibility and validity. Data were extracted in duplicate and pooled across studies using a random-effects model.

Results

The search yielded 7 RCTs that met the eligibility criteria. No difference was identified between the 2 methods in duration of air leak (weighted mean difference [WMD] 1.15 days, favours water seal; 95% confidence interval [CI] −0.64 to 2.94), time to discharge (WMD 2.19 d, favours water seal; 95% CI −0.63 to 5.01), duration of chest tubes (WMD 0.96 d, favours water seal; 95% CI −0.12 to 2.05) or incidence of prolonged air leaks (absolute risk reduction [ARR] 0.04, favours water seal; 95% CI −0.01 to 0.09). Water seal was associated with a significantly increased incidence of postoperative pneumothorax (ARR −0.14, 95% CI −0.21 to −0.07).

Conclusion

No differences were identified in terms of duration of air leak, incidence of prolonged air leak, duration of chest tubes and duration of hospital stay when chest tubes were placed to suction rather than water seal. Chest tube suction appears to be superior to water seal in reducing the incidence of pneumothorax; however, the clinical significance of this finding is unclear.