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British Journal of Anaesthesia Jul 2023Postoperative ulnar neuropathy (PUN) is an injury manifesting in the sensory or motor distribution of the ulnar nerve after anaesthesia or surgery. The condition... (Review)
Review
BACKGROUND
Postoperative ulnar neuropathy (PUN) is an injury manifesting in the sensory or motor distribution of the ulnar nerve after anaesthesia or surgery. The condition frequently features in cases of alleged clinical negligence by anaesthetists. We performed a systematic review and applied narrative synthesis with the aim of summarising current understanding of the condition and deriving implications for practice and research.
METHODS
Electronic databases were searched up to October 2022 for primary research, secondary research, or opinion pieces defining PUN and describing its incidence, predisposing factors, mechanism of injury, clinical presentation, diagnosis, management, and prevention.
RESULTS
We included 83 articles in the thematic analysis. PUN occurs after approximately 1 in 14 733 anaesthetics. Men aged 50-75 yr with pre-existing ulnar neuropathy are at highest risk. Preventative measures, based on consensus and expert opinion, are summarised, and an algorithm of suspected PUN management is proposed, based upon the identified literature.
CONCLUSIONS
Postoperative ulnar neuropathy is rare and the incidence is probably decreasing over time with general improvements in perioperative care. Recommendations to reduce the risk of postoperative ulnar neuropathy are based on low-quality evidence but include anatomically neutral arm positioning and padding intraoperatively. In selected high-risk patients, further documentation of repositioning, intermittent checks, and neurological examination in the recovery room can be helpful.
Topics: Male; Humans; Ulnar Neuropathies; Ulnar Nerve; Anesthesia; Postoperative Period; Incidence
PubMed: 37198029
DOI: 10.1016/j.bja.2023.04.010 -
Aging Clinical and Experimental Research Mar 2022To determine the postoperative effectiveness of trimodal prehabilitation in older surgical patients. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the postoperative effectiveness of trimodal prehabilitation in older surgical patients.
METHODS
We searched Medline, PubMed, Embase, the Cochrane Library, Web of Science, and ClinicalTrials.gov for observational cohort studies and randomised controlled trials (RCTs) of older surgical patients who underwent trimodal prehabilitation. We performed a meta-analysis to estimate the pooled risk ratio (RR) for dichotomous data and weighted mean difference (MD) for continuous data. Primary outcomes were postoperative mortality and complications, and the secondary outcomes were the 6-min walk test (6MWT) at 4 and 8 weeks after surgery, readmission, and length of hospital stay (LOS). This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42020201347).
RESULTS
We included 10 studies (four RCTs and six cohort studies) comprising 1553 older surgical patients (trimodal prehabilitation group, n = 581; control group, n = 972). There were no significant differences in postoperative mortality (RR 1.32; 95% confidence interval [CI] 0.52-3.35) and postoperative complications (RR 0.91; 95% CI 0.76-1.09). Prehabilitation did not reduce readmission (RR 0.92; 95% CI 0.61-1.38) and LOS (MD 0.10; 95% CI - 0.34-0.53). In a sub-analysis, trimodal prehabilitation did not significantly improve postoperative mortality, postoperative complications, readmission rates, or LOS when compared with standard care. However, trimodal prehabilitation significantly improved the 6MWT at 4 weeks after surgery (MD 37.49; 95% CI 5.81-69.18).
CONCLUSIONS
Our systematic review and meta-analysis demonstrated that trimodal prehabilitation did not reduce postoperative mortality and complications significantly but improved postoperative functional status in older surgical patients. Therefore, more high-quality trials are required.
Topics: Aged; Humans; Length of Stay; Postoperative Complications; Postoperative Period; Preoperative Exercise; Walk Test
PubMed: 34227052
DOI: 10.1007/s40520-021-01929-5 -
European Journal of Anaesthesiology Jul 2021To investigate the association of pre-operative proteinuria with postoperative acute kidney injury (AKI) development as well as the requirement for a renal replacement... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate the association of pre-operative proteinuria with postoperative acute kidney injury (AKI) development as well as the requirement for a renal replacement therapy (RRT) and mortality at short-term and long-term follow-up.
BACKGROUND
Postoperative AKI is associated with surgical morbidity and mortality. Pre-operative proteinuria is potentially a risk factor for postoperative AKI and mortality. However, the results in literature are conflicting.
METHODS
We searched PubMed, Embase, Scopus, Web of Science and Cochrane Library from the inception through to 3 June 2020. Observational cohort studies investigating the association of pre-operative proteinuria with postoperative AKI development, requirement for RRT, and all-cause mortality at short-term and long-term follow-up were considered eligible. Using inverse variance method with a random-effects model, the pooled effect estimates and 95% confidence interval (CI) were calculated.
RESULTS
Twenty-eight studies were included. Pre-operative proteinuria was associated with postoperative AKI development [odds ratio (OR) 1.74, 95% CI, 1.45 to 2.09], in-hospital RRT (OR 1.70, 95% CI, 1.25 to 2.32), requirement for RRT at long-term follow-up [hazard ratio (HR) 3.72, 95% CI, 2.03 to 6.82], and long-term all-cause mortality (hazard ratio 1.50, 95% CI, 1.30 to 1.73). In the subgroup analysis, pre-operative proteinuria was associated with increased odds of postoperative AKI in both cardiovascular (OR 1.77, 95% CI, 1.47 to 2.14) and noncardiovascular surgery (OR 1.63, 95% CI, 1.01 to 2.63). Moreover, there is a stepwise increase in OR of postoperative AKI development when the quantity of proteinuria increases from trace to 3+.
CONCLUSION
Pre-operative proteinuria is significantly associated with postoperative AKI and long-term mortality. Pre-operative anaesthetic assessment should take into account the presence of proteinuria to identify high-risk patients.
PROSPERO REGISTRATION
CRD42020190065.
Topics: Acute Kidney Injury; Humans; Postoperative Period; Proteinuria; Renal Replacement Therapy; Risk Factors
PubMed: 34101638
DOI: 10.1097/EJA.0000000000001542 -
Journal of Perianesthesia Nursing :... Dec 2017Internationally there is no consensus on the indicators essential for determining safe recovery from anesthesia and patient readiness for discharge from the... (Review)
Review
PURPOSE
Internationally there is no consensus on the indicators essential for determining safe recovery from anesthesia and patient readiness for discharge from the postanesthesia care unit (PACU).
DESIGN
Integrative review.
METHODS
Using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) as a search strategy, the literature related to PACU discharge scores were evaluated and organized into themes.
FINDINGS
The traditional components of airway support, oxygenation, sedation, and circulation are common within many first stage PACU discharge scores. However, there is strong support from the literature for components such as heart rate, temperature, pain, postoperative nausea and vomiting (PONV), urine output, and surgical site assessment to also be included. The review revealed that there is no standardized time frequency in applying a first stage PACU discharge score to patients within the PACU environment.
CONCLUSIONS
There is a need for the development and trial of an evidence based first stage PACU discharge score.
Topics: Adult; Aged; Anesthesia Recovery Period; Body Temperature; Female; Heart Rate; Humans; Male; Middle Aged; Pain, Postoperative; Postanesthesia Nursing; Postoperative Nausea and Vomiting; Urination
PubMed: 29157762
DOI: 10.1016/j.jopan.2016.10.007 -
Stroke Jun 2019Background and Purpose- Although believed to be transient and self-limiting, new-onset perioperative/postoperative atrial fibrillation (POAF) might be a risk factor for... (Meta-Analysis)
Meta-Analysis
Background and Purpose- Although believed to be transient and self-limiting, new-onset perioperative/postoperative atrial fibrillation (POAF) might be a risk factor for stroke and mortality. We conducted a systematic review and meta-analysis to qualitatively and quantitatively evaluate the relationship of POAF with early and late risks of mortality and stroke. Methods- We searched Pubmed, EMBASE, and Cochrane Library (1966 through March 2018) to identify cohort studies that reported stroke and mortality associated with POAF. We computed a random-effects estimate based on the Mantel-Haenszel method. Odds ratios with 95% CI were used as a measure of the association between POAF and early (in-hospital or within 30 days of surgery) stroke and mortality, while hazard ratios (HR) were used for long-term outcomes. Results- Our analysis included 35 studies with 2 458 010 patients. Pooling the results from the random-effects model showed that POAF was associated with increased risks of early stroke (odds ratio, 1.62; 95% CI, 1.47-1.80), early mortality (odds ratios, 1.44; 95% CI, 1.11-1.88), long-term stroke (HR, 1.37; 95% CI, 1.07-1.77), and long-term mortality (HR, 1.37; 95% CI, 1.27-1.49). Analyses focusing on high-quality studies obtained similar results. In subgroup analyses, POAF was more strongly associated with stroke in patients undergoing noncardiac surgery (HR, 2.00; 95% CI, 1.70-2.35) than in patients undergoing cardiac surgery (HR, 1.20; 95% CI, 1.07-1.34). Conclusions- New-onset POAF is associated with an increased risk of stroke and mortality, both in the short-term and long-term. The best strategy to reduce stroke risk among these patients needs to be determined.
Topics: Aged; Atrial Fibrillation; Cardiac Surgical Procedures; Female; Humans; Male; Middle Aged; Postoperative Complications; Postoperative Period; Proportional Hazards Models; Risk Factors; Stroke
PubMed: 31043148
DOI: 10.1161/STROKEAHA.118.023921 -
Clinical Hemorheology and... 2022The incidence of postoperative microcirculatory flow alterations and their effect on outcome have not been studied extensively. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The incidence of postoperative microcirculatory flow alterations and their effect on outcome have not been studied extensively.
OBJECTIVE
This systematic review and meta-analysis were designed to investigate the presence of sublingual microcirculatory flow alterations during the immediate and early postoperative period and their correlation with complications and survival.
METHODS
A systematic search of PubMed, Scopus, Embase, PubMed Central, and Google Scholar was conducted for relevant articles from January 2000 to March 2021. Eligibility criteria were randomized controlled and non-randomized trials. Case reports, case series, review papers, animal studies and non-English literature were excluded. The primary outcome was the assessment of sublingual microcirculatory alterations during the immediate and early postoperative period in adult patients undergoing surgery. Risk of bias was assessed with the Ottawa-Newcastle scale. Standard meta-analysis methods (random-effects models) were used to assess the difference in microcirculation variables.
RESULTS
Thirteen studies were included. No statistically significant difference was found between preoperative and postoperative total vessel density (p = 0.084; Standardized Mean Difference (SMD): -0.029; 95%CI: -0.31 to 0.26; I2 = 22.55%). Perfused vessel density significantly decreased postoperatively (p = 0.035; SMD: 0.344; 95%CI: 0.02 to 0.66; I2 = 65.66%), while perfused boundary region significantly increased postoperatively (p = 0.031; SMD: -0.415; 95%CI: -0.79 to -0.03; I2 = 37.21%). Microvascular flow index significantly decreased postoperatively (p = 0.028; SMD: 0.587; 95%CI: 0.06 to 1.11; I2 = 86.09%), while no statistically significant difference was found between preoperative and postoperative proportion of perfused vessels (p = 0.089; SMD: 0.53; 95%CI: -0.08 to 1.14; I2 = 70.71%). The results of the non-cardiac surgery post-hoc analysis were comparable except that no statistically significant difference in perfused vessel density was found (p = 0.69; SMD: 0.07; 95%CI: -0.26 to 0.39; I2 = 0%).
LIMITATIONS
The included studies investigate heterogeneous groups of surgical patients. There were no randomized controlled trials.
CONCLUSIONS
Significant sublingual microcirculatory flow alterations are present during the immediate and early postoperative period. Further research is required to estimate the correlation of sublingual microcirculatory flow impairment with complications and survival.
Topics: Humans; Microcirculation; Postoperative Period
PubMed: 34719484
DOI: 10.3233/CH-211214 -
Pediatric Surgery International Jan 2022Hirschsprung's associated enterocolitis (HAEC) is a complication of Hirschsprung's Disease (HD) with considerable morbidity and mortality. The variability in...
PURPOSE
Hirschsprung's associated enterocolitis (HAEC) is a complication of Hirschsprung's Disease (HD) with considerable morbidity and mortality. The variability in presentation leads to a wide variety of the reported prevalence pre-and postoperatively. This systematic review aimed to clarify the prevalence of HAEC in short-(S-HD), long (L-HD), TCA and the type of operation used.
METHODS
A systematic literature-based search for relevant cohorts was performed using Pubmed/Medline, Cochrane Library from its inception to May 2021. Studies reporting on pre-and postoperative enterocolitis, segment length, and surgical procedure (Soave, Swenson, Duhamel) were included. Pooled prevalence and subgroup analysis have been calculated for pre-and postoperative HAEC.
RESULTS
4738 articles were identified from the literature search, among which 57 studies, including 9744 preoperative and 8568 postoperative patients, were included. The groups were sorted by length of the aganglionic segment for further analysis. The pooled prevalence for preoperative HAEC was 18.3% for all types, 15.2% for S-HD and 26.1% for TCA. The pooled prevalence for postoperative HAEC was in total 18.2% for all segment lengths and used techniques. Subgroup analysis showed no significant difference in the occurrence of postoperative enterocolitis between the three techniques.
CONCLUSION
The prevalence of preoperative HAEC increases with segment length. However, pooled data suggest that the postoperative risk for developing HAEC, independently of the employed method and segment length, is comparable to the preoperative risk.
Topics: Enterocolitis; Hirschsprung Disease; Humans; Infant; Morbidity; Postoperative Complications; Postoperative Period; Prevalence
PubMed: 34595554
DOI: 10.1007/s00383-021-05020-y -
Journal of Clinical Anesthesia Feb 2023Obstructive sleep apnea (OSA) is prevalent in surgical patients and is associated with an increased risk of adverse perioperative events. (Meta-Analysis)
Meta-Analysis Review
The effectiveness of positive airway pressure therapy in reducing postoperative adverse outcomes in surgical patients with obstructive sleep apnea: A systematic review and meta-analysis.
IMPORTANCE
Obstructive sleep apnea (OSA) is prevalent in surgical patients and is associated with an increased risk of adverse perioperative events.
STUDY OBJECTIVE
To determine the effectiveness of positive airway pressure (PAP) therapy in reducing the risk of postoperative complications in patients with OSA undergoing surgery.
DESIGN
Systematic review and meta-analysis searching Medline and other databases from inception to October 17, 2021. The search terms included: "positive airway pressure," "surgery," "post-operative," and "obstructive sleep apnea." The inclusion criteria were: 1) adult patients with OSA undergoing surgery; (2) patients using preoperative and/or postoperative PAP; (3) at least one postoperative outcome reported; (4) control group (patients with OSA undergoing surgery without preoperative and/or postoperative PAP therapy); and (5) English language articles.
PATIENTS
Twenty-seven studies included 30,514 OSA patients undergoing non-cardiac surgery and 837 OSA patients undergoing cardiac surgery.
INTERVENTION
PAP therapy MAIN RESULTS: In patients with OSA undergoing non-cardiac surgery, PAP therapy was associated with a decreased risk of postoperative respiratory complications (2.3% vs 3.6%; RR: 0.72, 95% CI: 0.51-1.00, asymptotic P = 0.05) and unplanned ICU admission (0.12% vs 4.1%; RR: 0.44, 95% CI: 0.19-0.99, asymptotic P = 0.05). No significant differences were found for all-cause complications (11.6% vs 14.4%; RR: 0.89, 95% CI: 0.74-1.06, P = 0.18), postoperative cardiac and neurological complications, in-hospital length of stay, and in-hospital mortality between the two groups. In patients with OSA undergoing cardiac surgery, PAP therapy was associated with decreased postoperative cardiac complications (33.7% vs 50%; RR: 0.63, 95% CI: 0.51-0.77, P < 0.0001), and postoperative atrial fibrillation (40.1% vs 66.7%; RR: 0.59, 95% CI 0.45-0.77, P < 0.0001).
CONCLUSION
In patients with OSA undergoing non-cardiac surgery, PAP therapy was associated with a 28% reduction in the risk of postoperative respiratory complications and 56% reduction in unplanned ICU admission. In patients with OSA undergoing cardiac surgery, PAP therapy decreased the risk of postoperative cardiac complications and atrial fibrillation by 37% and 41%, respectively.
Topics: Adult; Humans; Atrial Fibrillation; Risk Factors; Sleep Apnea, Obstructive; Postoperative Period; Cardiac Surgical Procedures; Postoperative Complications; Heart Diseases
PubMed: 36347195
DOI: 10.1016/j.jclinane.2022.110993 -
BMC Surgery Nov 2017Laparoscopic distal pancreatectomy (LDP) reduces postoperative morbidity, hospital stay and recovery as compared with open distal pancreatectomy. Many authors believe... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Laparoscopic distal pancreatectomy (LDP) reduces postoperative morbidity, hospital stay and recovery as compared with open distal pancreatectomy. Many authors believe that robotic surgery can overcome the difficulties and technical limits of LDP thanks to improved surgical manipulation and better visualization. Few studies in the literature have compared the two methods in terms of surgical and oncological outcome. The aim of this study was to compare the results of robotic (RDP) and laparoscopic distal pancreatectomy.
METHODS
A systematic review and meta-analysis was conducted of control studies published up to December 2016 comparing LDP and RDP. Two Reviewers independently assessed the eligibility and quality of the studies. The meta-analysis was conducted using either the fixed-effect or the random-effect model.
RESULTS
Ten studies describing 813 patients met the inclusion criteria. This meta-analysis shows that the RDP group had a significantly higher rate of spleen preservation [OR 2.89 (95% confidence interval 1.78-4.71, p < 0.0001], a lower rate of conversion to open OR 0.33 (95% CI 0.12-0.92), p = 0.003] and a shorter hospital stay [MD -0.74; (95% CI -1.34 -0.15), p = 0.01] but a higher cost than the LDP group, while other surgical outcomes did not differ between the two groups.
CONCLUSION
This meta-analysis suggests that the RDP procedure is safe and comparable in terms of surgical results to LDP. However, even if the RDP has a higher cost compared to LDP, it increases the rate of spleen preservation, reduces the risk of conversion to open surgery and is associated to shorter length of hospital stay.
Topics: Conversion to Open Surgery; Humans; Laparoscopy; Length of Stay; Pancreatectomy; Postoperative Period; Robotic Surgical Procedures; Spleen; Treatment Outcome
PubMed: 29121885
DOI: 10.1186/s12893-017-0301-3 -
The British Journal of Oral &... Jun 2022The purpose of this study was to systemically analyse the effects of photobiomodulation therapy (PBMT) on implant stability and postoperative recovery. Electronic... (Meta-Analysis)
Meta-Analysis Review
The purpose of this study was to systemically analyse the effects of photobiomodulation therapy (PBMT) on implant stability and postoperative recovery. Electronic searches on MEDLINE (PubMed), Cochrane Library, EMBASE, and Web of Science were completed independently by two researchers in February 2021, and a manual search was performed for the references of the included articles. The primary outcome was implant stability. The secondary outcome was postoperative recovery, including postoperative pain, recovery of peri-implant hard tissue (marginal bone loss and bone mineral density), facial swelling, and peri-implant clinical parameters. Twenty studies were finally obtained (17 randomised controlled, and 3 controlled clinical studies). Meta-analysis revealed that PBMT increased implant stability at 10 days after insertion (MD 2.27, 95% CI: 0.40 to 4.13, P = 0.020), and reduced marginal bone loss at 6 months after insertion (MD -0.16, 95% CI: -0.23 to -0.08, P < 0.001). However, no significant improvements were noted in implant stability two weeks (P = 0.070), three weeks (P = 0.090), six weeks (P = 0.050), and 12 weeks (P = 0.080) after insertion. Qualitative analysis suggested that PBMT could not alleviate postoperative pain, increase bone mineral density, or improve peri-implant clinical parameters. It was effective only in reducing facial swelling. This study suggests that the effects of PBMT on implant stability and postoperative recovery may be limited.
Topics: Bone Density; Dental Implants; Humans; Low-Level Light Therapy; Pain, Postoperative; Postoperative Period
PubMed: 35490059
DOI: 10.1016/j.bjoms.2022.01.014