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JBJS Reviews Aug 2023Return to work (RTW) and sports (RTS) are critical gauges to improvement among patients after total hip arthroplasty (THA). This study aimed to determine rates,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Return to work (RTW) and sports (RTS) are critical gauges to improvement among patients after total hip arthroplasty (THA). This study aimed to determine rates, timelines, and prognostic factors associated with RTW and RTS outcomes after primary THA.
METHODS
A systematic review was conducted on MEDLINE, EMBASE, and CENTRAL databases with 57 studies meeting inclusion/exclusion criteria. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions and risk of bias in randomized trials (RoB2) tools. Meta-analysis and pooled analysis were conducted, with forest plots to summarize odds ratios and 95% confidence interval (CI).
RESULTS
The pooled RTW rate across all studies was 70% (95% CI, 68%-80%), with rates varying significantly from 11% to 100%. The mean time to RTW was 11.2 weeks (range 1-27). A time point analysis showed increasing RTW rates with a maximum rate at 2 years of 90%. Increased age (p < 0.001) and preoperative heavy labor (p = 0.005) were associated with lower RTW rates. The RTS rate ranged from 42% to 100%, with a pooled rate of 85% (95% CI, 74%-92%). The mean time to RTS was 16.1 weeks (range 8-26). The RTS ranged from 20% to 80% with a pooled proportion of 56% (95% CI, 42%-70%, I2 = 90%) for high-intensity sports and from 75% to 100% for low-intensity sports with a pooled proportion of 97% (95% CI, 83-99, I2 = 93%).
CONCLUSION
Most patients RTW and RTS after THA in an increasing manner as time passes with rates more than 85% after 1 year. These rates may be greatly affected by various factors, most notably age, the intensity of the sport, and the type of work performed. In general, young patients, low-demand work or sports can be resumed as soon as 4 to 6 weeks after surgery, but with increased restrictions as the intensity increases. This information should be used by practitioners to manage postoperative expectations and provide appropriate recommendations to patients.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Arthroplasty, Replacement, Hip; Return to Sport; Return to Work; Sports; Postoperative Period
PubMed: 37549241
DOI: 10.2106/JBJS.RVW.22.00249 -
The Laryngoscope Jan 2019Perioperative antibiotic prophylaxis in patients undergoing surgery for maxillofacial fractures is standard practice. However, the use of postoperative antibiotic... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Perioperative antibiotic prophylaxis in patients undergoing surgery for maxillofacial fractures is standard practice. However, the use of postoperative antibiotic prophylaxis remains controversial. This systematic review and meta-analysis sought to evaluate the effect of postoperative antibiotic therapy on the incidence of surgical site infection (SSI) in patients with maxillofacial fractures.
METHODS
MEDLINE, Embase, and the Cochrane Library were searched from inception through October 2017. Randomized controlled trials (RCTs) and cohort studies evaluating the efficacy of pre-, peri-, and postoperative antibiotic prophylaxis in preventing SSI in maxillofacial fractures were included. Data were extracted from studies using a standardized data collection form, with two reviewers independently performing extraction and quality assessment for each study. Risk ratios (RRs) for SSI were pooled using a random-effects model.
RESULTS
Among 2,150 potentially eligible citations, 13 studies met inclusion criteria and provided data to be included in a meta-analysis. The addition of postoperative antibiotic prophylaxis to a standard preoperative and/or perioperative antibiotic regimen showed no significant difference in the risk of SSI (RR = 1.11 [95% CI: 0.86-1.44], P > .1). There were also no differences in the risk of SSI when restricting the analysis to mandibular fractures (eight studies, RR = 1.22 [95% CI: 0.92-1.62]) or open surgical techniques (eight studies, RR = 1.02 [95% CI: 0.62-1.67]). A sensitivity analysis did not find any significant differences in risk when restricting to RCTs (seven trials, RR = 1.00 [95% CI: 0.61-1.67]) or cohort studies (six studies, RR = 1.21 [95% CI: 0.89-1.63]).
CONCLUSIONS
Our findings, along with the available evidence, does not support the routine use of postoperative antibiotic prophylaxis in patients with maxillofacial fractures. Avoiding the unnecessary use of antibiotic therapy in the postoperative period could have important implications for healthcare costs and patient outcomes. Laryngoscope, 129:82-95, 2019.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cohort Studies; Female; Humans; Incidence; Male; Maxillofacial Injuries; Postoperative Care; Postoperative Period; Randomized Controlled Trials as Topic; Surgical Wound Infection; Treatment Outcome
PubMed: 29756330
DOI: 10.1002/lary.27210 -
Arthroscopy : the Journal of... Sep 2016To systematically review meniscal radial tear repair procedures and compare the techniques, outcomes, and complications. (Review)
Review
PURPOSE
To systematically review meniscal radial tear repair procedures and compare the techniques, outcomes, and complications.
METHODS
Studies were identified through a systematic review of the literature using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2014), Medline (1980-2014), and Embase. Inclusion criteria included a minimum follow-up of 24 months, English language, and publications from 1980 or later. Exclusion criteria were surgical techniques not reporting follow-up, biomechanical studies, cadaver/anatomic studies, and non-radial tear meniscal repair procedures. Meniscal radial repair, meniscal radial tear, meniscal radial tear repair, radial repair and radial tear were used as search terms.
RESULTS
A total of 6 studies (55 patients) met the inclusion criteria. The mean duration of follow-up ranged from 24 to 71 months. Of the 6 studies, 5 reported radial tears to the lateral meniscus and 1 study reported cases of both medial and lateral meniscal radial tears. Two studies reported different inside-out repair techniques, 2 studies reported the use of an all-inside anchor-based repair system, 1 study reported an all-inside repair technique with absorbable sutures, and 1 study reported an inside-out repair with fibrin clots. Average postoperative Lysholm scores were reported in all 6 studies and ranged from 86.9 to 95.6. Average postoperative Tegner activity scores were reported in 4 studies and ranged from 1 to 6.7. The majority of studies concluded that their techniques produced satisfactory healing of the radial tear, without serious subsequent complications.
CONCLUSIONS
Radial repair techniques differed among studies; however, postoperative subjective outcomes revealed patient improvement with repairing radial tears. With the increasing concern of long-term osteoarthritis after meniscectomy, meniscal preservation with repair of radial tears results in improved short-term clinical outcomes; however, long-term outcomes remain unknown.
LEVEL OF EVIDENCE
Level IV, systematic review of level IV studies.
Topics: Arthroscopy; Follow-Up Studies; Humans; Knee Injuries; Knee Joint; Lysholm Knee Score; Menisci, Tibial; Osteoarthritis; Postoperative Period; Sutures; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 27234653
DOI: 10.1016/j.arthro.2016.03.029 -
World Journal of Surgery Sep 2018The survival benefits, oncological adequacy, effectiveness, and safety of laparoscopic transverse colectomy (LTC) were compared with that of open transverse colectomy... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The survival benefits, oncological adequacy, effectiveness, and safety of laparoscopic transverse colectomy (LTC) were compared with that of open transverse colectomy (OTC) using a meta-analysis.
METHODS
EMBASE, Medline, Cochrane library, and Google scholar databases were searched for the last 20 years. Meta-analyses were performed using both fixed-effects and random-effects models. Five-year disease-free survival and overall survival were estimated using the inverse variance hazard ratio method.
RESULTS
No survival benefits were detected between the two LTC and OTC cohorts. OTC showed shorter operative time by 38 min compared to LTC [mean difference (MD) = 38(15.23-60.77), p = 0.001]. However, LTC was associated with earlier postoperative recovery. The time to flatus and time to oral intake for LTC were MD = -1.12(-1.68 to -0.55, p = 0.001) and MD = -1.57(-2.38 to -0.76, p = 0.001), respectively. In addition, LTC was associated with a shorter hospital stay by 4.5 days [MD = -4.64(-7.52 to -1.75), p = 0.002].
CONCLUSIONS
Compared to OTC, LTC provides similar survival benefits, earlier postoperative recovery, and shorter hospital stay by 4.5 days.
Topics: Colectomy; Colon, Transverse; Colonic Neoplasms; Disease-Free Survival; Eating; Humans; Laparoscopy; Length of Stay; Operative Time; Postoperative Period; Recovery of Function; Survival Rate
PubMed: 29523909
DOI: 10.1007/s00268-018-4570-5 -
Neurosurgical Review Oct 2021Over the last few years, the role of early postoperative computed tomography (EPOCT) after cranial surgery has been repeatedly questioned, but there is yet no consensus... (Review)
Review
Over the last few years, the role of early postoperative computed tomography (EPOCT) after cranial surgery has been repeatedly questioned, but there is yet no consensus on the practice. We conducted a systematic review to address the usefulness of EPOCT in association with neurological examination after elective craniotomies compared to the neurological examination alone. Studies were eligible if they provided information about the number of patients scanned, how many were asymptomatic or presented neurological deterioration before the scan and how many of each of those groups had their management changed due to imaging findings. CTs had to be performed in the first 48 h following surgery to be considered early. Eight studies were included. The retrospective studies enrolled a total of 3639 patients, with 3737 imaging examinations. Out of the 3696 CT scans performed in asymptomatic patients, less than 0.8% prompted an intervention, while 100% of patients with neurological deterioration were submitted to emergency surgery. Positive predictive values of altered scans were 0.584 for symptomatic patients and 0.125 for the asymptomatic. The number of altered scans necessary to predict (NNP) one change in management for the asymptomatic patients was 8, while for the clinically evident cases, it was 1.71. The number of scans needed to diagnose one clinically silent alteration is 134.75, and postoperative imaging of neurologically intact patients is 132 times less likely to issue an emergency intervention than an altered neurological examination alone. EPOCT following elective craniotomy in neurologically preserved patients is not supported by current evidence, and CT scanning should be performed only in particular conditions. The authors have developed an algorithm to help the judgment of each patient by the surgeon in a resource-limited context.
Topics: Algorithms; Craniotomy; Humans; Postoperative Period; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 33452594
DOI: 10.1007/s10143-021-01473-w -
The Surgeon : Journal of the Royal... Aug 2021Midline laparotomy is an unavoidable approach to many surgical procedures. Many surgeons prescript the use of postoperative abdominal binder during the first... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Midline laparotomy is an unavoidable approach to many surgical procedures. Many surgeons prescript the use of postoperative abdominal binder during the first mobilization after surgery. The use and the cost effective of this device is still debated by many surgeons.
METHODS
PubMed, EMBASE and the CENTRAL were systematically searched for randomized controlled trials (RCT) comparing patients who wore abdominal binder ("binder") and patient who did not wear any abdominal binder ("non-binder") up to March 2020. The primary outcomes measured in the comparison were postoperative pain, pulmonary functions, the entity of physical activity, the comfort. A meta-analysis of relevant studies was performed using RevMan 5.3.
RESULTS
wearing an abdominal binder after midline laparotomy seems to reduce postoperative pain on first and third postoperative day, to improve the physical activity on third postoperative day, and not affect pulmonary functions. Generally, an elastic abdominal binder is well tolerated during postoperative.
CONCLUSIONS
the use of elastic abdominal binder permits a comfortable early postoperative mobilization reducing pain, increases physical activity and seems to not affect pulmonary functions.
Topics: Abdomen; Humans; Laparotomy; Pain, Postoperative; Postoperative Period; Randomized Controlled Trials as Topic
PubMed: 32773235
DOI: 10.1016/j.surge.2020.07.003 -
Chest Nov 2020Studies have demonstrated that high-flow nasal cannula (HFNC) prevents intubation in acute hypoxic respiratory failure when compared with conventional oxygen therapy... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Studies have demonstrated that high-flow nasal cannula (HFNC) prevents intubation in acute hypoxic respiratory failure when compared with conventional oxygen therapy (COT). However, the data examining routine HFNC use in the immediate postoperative period are less clear.
RESEARCH QUESTION
Is routine HFNC use superior to COT or noninvasive ventilation (NIV) use in preventing intubation in patients postoperatively?
STUDY DESIGN AND METHODS
We comprehensively searched databases (PubMed, Embase, Web of Science) to identify randomized controlled trials (RCTs) that compared the effect of HFNC use with that of COT or NIV in the immediate postoperative period on reintubation, escalation of respiratory support, hospital mortality, ICU and hospital length of stay (LOS), postoperative hypoxemia, and treatment complications. We assessed individual study risk of bias (RoB) by using the revised Cochrane RoB 2 tool and rated certainty in outcomes by using the Grading of Recommendations Assessment, Development and Evaluation framework.
RESULTS
We included 11 RCTs enrolling 2,201 patients. Ten compared HFNC with COT and one with NIV. Compared with COT use, HFNC use in the postoperative period was associated with a lower reintubation rate (relative risk [RR], 0.32; 95% CI, 0.12-0.88; absolute risk reduction [ARR], 2.9%; moderate certainty) and decreased escalation of respiratory support (RR, 0.54; 95% CI, 0.31-0.94; ARR, 5.8%; very low certainty). Post hoc subgroup analysis suggested that this effect was driven by patients who were obese and/or at high risk (subgroup differences, P = .06). We did not find differences in any of the other stated outcomes between HFNC and COT. HFNC was also no different from NIV in reintubation rate, respiratory therapy failure, or ICU LOS.
INTERPRETATION
With evidence of moderate certainty, prophylactic HFNC reduces reintubation and escalation of respiratory support compared with COT in the immediate postoperative period after cardiothoracic surgery. This effect is likely driven by patients who are at high risk and/or obese. These findings support postoperative prophylactic HFNC use in the patients who are at high risk and/or obese undergoing cardiothoracic surgery.
Topics: Cannula; Humans; Noninvasive Ventilation; Oxygen Inhalation Therapy; Postoperative Period; Respiratory Insufficiency
PubMed: 32615190
DOI: 10.1016/j.chest.2020.06.038 -
Head & Neck Feb 2022There has been increased interest in the use of transoral surgery (TOS) for the treatment of oropharyngeal cancer (OPC). This systematic review summarizes the available... (Review)
Review
There has been increased interest in the use of transoral surgery (TOS) for the treatment of oropharyngeal cancer (OPC). This systematic review summarizes the available evidence for validated functional outcomes following TOS for OPC, within the early postoperative period. Key databases were searched. Primary TOS resections of human subjects were included. Validated functional outcomes extracted included instrumental assessment, clinician rated, and patient reported measures. Database searches yielded 7186 titles between 1990 and December 2020. Full-text articles were obtained for 296 eligible studies, which were screened and a resulting 14 studies, comprising 665 participants were included in the review. Oropharyngeal dysfunction following TOS was observed across all three categories of outcome measures (OMs) reported and was dependent on pretreatment function, T-classification, and tumor volume. Future investigations should include optimal OMs to be used in the postoperative setting to allow for conclusive comparisons.
Topics: Humans; Oropharyngeal Neoplasms; Postoperative Period
PubMed: 34882886
DOI: 10.1002/hed.26938 -
BMC Surgery Aug 2020Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be ascertained with synthesis of available evidence. The aim of this systematic review and meta-analysis was to investigate the association between obesity and outcomes of patients after laparoscopic adrenalectomy.
METHODS
We searched EMBASE, PubMed, Global Index Medicus, and Web of Science, without language restriction, to identify cohort studies published between January 1, 2000 and November 6, 2019. We considered studies with data comparing outcomes of adults with and without obesity after laparoscopic adrenalectomy. Random-effects meta-analysis was used to pool study-specific estimates. This review was registered with PROSPERO, CRD42018117070.
RESULTS
Five studies with data on a pooled sample of 353 patients with obesity and 828 without were included in the meta-analysis. The risk of bias was moderate to low. We found no association between obesity and the various stages of postoperative complications: Clavien-Dindo grade 1 (OR = 1.57; 95%CI = 0.55-4.48; I = 44.6%), grade 2 (OR = 1.12; 95%CI = 0.54-2.32; I = 0.0%), grade 3 (OR = 1.79; 95%CI = 0.58-5.47; I = 0.0%;), grade 4 (OR = 0.43; 95%CI = 0.05-3.71; I = 0.0%), and grade 5 (death) (OR = 0.43; 95% CI = 0.02-14.31). Furthermore, no association was found between obesity and readmission rates (OR = 0.7; 95% CI = 0.13-3.62) and conversion of laparoscopic to open surgery (OR = 0.62; 95% CI = 0.16-2.34; I = 19.5%).
CONCLUSIONS
This study suggests that obesity is not associated with complications following laparoscopic adrenalectomy. This meta-analysis might have been underpowered to detect a true association between obesity and patient outcome after laparoscopic adrenalectomy due to the small number of included studies. Larger studies are needed to clarify the role of obesity in patients undergoing laparoscopic adrenalectomy.
Topics: Adrenalectomy; Adult; Humans; Laparoscopy; Obesity; Postoperative Complications; Postoperative Period
PubMed: 32867744
DOI: 10.1186/s12893-020-00848-y -
Psychiatry Research May 2024This systematic review and meta-analysis aimed to evaluate the impact of intraoperative and/or postoperative esketamine application on the prevention of postpartum... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis aimed to evaluate the impact of intraoperative and/or postoperative esketamine application on the prevention of postpartum depression (PPD). PubMed, Embase, and Web of Science were thoroughly searched for eligible randomized controlled trials (RCTs) regarding the application of esketamine for postnatal depression prevention. Nine RCTs including 1277 participants were involved in the final analysis. It was found that intraoperative and/or postoperative administration of esketamine significantly reduced the PPD incidence and the Edinburgh Postnatal Depression Scores in the early postoperative period. Meanwhile, esketamine lowered the occurrence of postoperative nausea and vomiting with no influence on other psychiatric symptoms.
Topics: Female; Humans; Depression, Postpartum; Ketamine; Postoperative Nausea and Vomiting; Postoperative Period
PubMed: 38579458
DOI: 10.1016/j.psychres.2024.115890