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European Journal of Surgical Oncology :... Sep 2017The role of preoperative biliary drainage (PBD) for hilar cholangiocarcinoma (HCC) remains unclear. The aim of this meta-analysis is to investigate the role of PBD in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The role of preoperative biliary drainage (PBD) for hilar cholangiocarcinoma (HCC) remains unclear. The aim of this meta-analysis is to investigate the role of PBD in the treatment of potentially resectable HCC.
METHODS
All studies reporting outcomes on patients with PBD vs without PBD were included. A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published between 1980 and 2016.
RESULTS
Initial search identified 667 articles. Only 9 studies met the inclusion criteria and were included in this analysis. No significant differences in mortality were observed between the two groups (RR = 0,935; 95% CI = 0,612 to 1429; p = 0,463). Overall morbidity was significantly higher in PBD group (RR = 1266; 95% CI = 1039 to 1543; p = 0,011). No significant differences in transfusion rate, hospital stay, anastomotic leaks, abdominal collections and operative time, were found. Wound infections were significantly higher in PBD group.
CONCLUSIONS
PBD seems to be associated with higher postoperative morbidity and increases the risk of wound infections. Further prospective studies are needed to better define the impact of PBD in outcomes after surgery for hilar cholangiocarcinoma.
Topics: Bile Duct Neoplasms; Blood Transfusion; Drainage; Humans; Klatskin Tumor; Length of Stay; Operative Time; Postoperative Complications; Preoperative Care
PubMed: 28477976
DOI: 10.1016/j.ejso.2017.04.001 -
World Journal of Surgery Oct 2023Surgery is often a complex process that requires detailed 3-dimensional anatomical knowledge and rigorous interplay between team members to attain ideal operational... (Review)
Review
BACKGROUND
Surgery is often a complex process that requires detailed 3-dimensional anatomical knowledge and rigorous interplay between team members to attain ideal operational efficiency or "flow." Virtual Reality (VR) represents a technology by which to rehearse complex plans and communicate precise steps to a surgical team prior to entering the operating room. The objective of this study was to evaluate the use of VR for preoperative surgical team planning and interdisciplinary communication across all surgical specialties.
METHODS
A systematic review of the literature was performed examining existing research on VR use for preoperative surgical team planning and interdisciplinary communication across all surgical fields in order to optimize surgical efficiency. MEDLINE, SCOPUS, CINAHL databases were searched from inception to July 31, 2022 using standardized search clauses. A qualitative data synthesis was performed with particular attention to preoperative planning, surgical efficiency optimization, and interdisciplinary collaboration/communication techniques determined a priori. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. All included studies were appraised for their quality using the Medical Education Research Study Quality Instrument (MERSQI) tool.
RESULTS
One thousand and ninety-three non-duplicated articles with abstract and full text availability were identified. Thirteen articles that examined preoperative VR-based planning techniques for optimization of surgical efficiency and/or interdisciplinary communication fulfilled inclusion and exclusion criteria. These studies had a low-to-medium methodological quality with a MERSQI mean score of 10.04 out of 18 (standard deviation 3.61).
CONCLUSIONS
This review demonstrates that time spent rehearsing and visualizing patient-specific anatomical relationships in VR may improve operative efficiency and communication across multiple surgical specialties.
Topics: Humans; Virtual Reality; Specialties, Surgical; Operating Rooms; Preoperative Care
PubMed: 37204439
DOI: 10.1007/s00268-023-07064-8 -
BMJ Open Dec 2017Clinics have been established to provide preoperative medical consultations, and enable the anaesthetist and surgeon to deliver the best surgical outcome for patients.... (Review)
Review
OBJECTIVE
Clinics have been established to provide preoperative medical consultations, and enable the anaesthetist and surgeon to deliver the best surgical outcome for patients. However, there is uncertainty regarding the effect of such clinics on surgical, in-hospital and long-term outcomes. A systematic review of the literature was conducted to determine the effectiveness of preoperative medical consultations by internal medicine physicians for patients listed for elective surgery.
DESIGN
Systematic searches of MEDLINE, EMBASE, CINAHL, PubMed, Current Contents and the NHS Centre for Reviews and Dissemination were conducted up to 30 April 2017.
SETTING
Elective surgery.
STUDY SELECTION
Randomised controlled trials and non-randomised comparative studies conducted in adults.
OUTCOME MEASURES
Length of hospital stay, perioperative morbidity and mortality, costs and quality of life.
RESULTS
The one randomised trial reported that preadmission preoperative assessment was more effective than the option of an inpatient medical assessment in reducing the frequency of unnecessary admissions with significantly fewer surgical cancellations following admission for surgery. A small reduction in length of stay in patients was also observed. The three non-randomised studies reported increased lengths of stay, costs and postoperative complications in patients who received preoperative assessment. The timing and delivery of the preoperative medical consultation in the intervention group differed across the included studies.
CONCLUSION
Further research is required to inform the design and implementation of coordinated involvement of physicians and surgeons in the provision of care for high-risk surgical patients. A standardised approach to perioperative decision-making processes should be developed with a clear protocol or guideline for the assessment and management of surgical patients.
Topics: Cost-Benefit Analysis; Elective Surgical Procedures; Humans; Internal Medicine; Length of Stay; Outcome Assessment, Health Care; Practice Patterns, Physicians'; Preoperative Care; Quality of Life; Randomized Controlled Trials as Topic; Referral and Consultation
PubMed: 29203506
DOI: 10.1136/bmjopen-2017-018632 -
Annals of Surgical Oncology Dec 2015Cancer patients experience anxiety and depression after diagnosis and during treatment. A wide range of psychological interventions have been proposed to alleviate... (Review)
Review
BACKGROUND
Cancer patients experience anxiety and depression after diagnosis and during treatment. A wide range of psychological interventions have been proposed to alleviate distress, but the evidence about the perioperative effectiveness of such interventions is not clear. This systematic review examined the effect of preoperative psychological interventions or prehabilitation on the postoperative outcomes of patients undergoing surgery for cancer.
METHODS
A systematic review of the published data was performed using Embase, Medline, and PsycInfo for the period from 1946 to February 2014. A total of 951 publications (case series, single case reports, and reviews) were found. Only seven of these studies included patients undergoing an operation for cancer and a preoperative psychological intervention.
RESULTS
Six of the seven studies were randomized controlled trials. Four were conducted with patients who had breast cancer (n = 356). The other studies included patients with gynecologic cancer (n = 30), colorectal cancer (n = 60), and prostate cancer (n = 159). Assessment of the studies showed four to be of good quality, two to be of moderate quality, and one to be of poor quality. Interventions did not affect traditional surgical outcomes (e.g., length of hospital stay, complications, analgesia use, or mortality) but positively affected patients' immunologic function. However, psychological interventions appeared to have an impact on patients' reported outcome measures including psychological outcomes, quality of life, and somatic symptoms.
CONCLUSION
Available data suggested that preoperative psychological prehabilitation may have a role for cancer patients undergoing surgery. Further evidence is needed to evaluate its role.
Topics: Humans; Neoplasms; Preoperative Care; Psychotherapy; Stress, Psychological
PubMed: 25869228
DOI: 10.1245/s10434-015-4550-z -
The Cochrane Database of Systematic... Sep 2015Haemodialysis treatment requires reliable vascular access. Optimal access is provided via functional arteriovenous fistula (fistula), which compared with other forms of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Haemodialysis treatment requires reliable vascular access. Optimal access is provided via functional arteriovenous fistula (fistula), which compared with other forms of vascular access, provides superior long-term patency, requires few interventions, has low thrombosis and infection rates and cost. However, it has been estimated that between 20% and 60% of fistulas never mature sufficiently to enable haemodialysis treatment. Mapping blood vessels using imaging technologies before surgery may identify vessels that are most suitable for fistula creation.
OBJECTIVES
We compared the effect of conducting routine radiological imaging evaluation for vascular access creation preoperatively with standard care without routine preoperative vessel imaging on fistula creation and use.
SEARCH METHODS
We searched Cochrane Kidney and Transplant's Specialised Register to 14 April 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that enrolled adult participants (aged ≥ 18 years) with chronic or end-stage kidney disease (ESKD) who needed fistulas (both before dialysis and after dialysis initiation) that compared fistula maturation rates relating to use of imaging technologies to map blood vessels before fistula surgery with standard care (no imaging).
DATA COLLECTION AND ANALYSIS
Two authors assessed study quality and extracted data. Dichotomous outcomes, including fistula creation, maturation and need for catheters at dialysis initiation, were expressed as risk ratios (RR) with 95% confidence intervals (CI). Continuous outcomes, such as numbers of interventions required to maintain patency, were expressed as mean differences (MD). We used the random-effects model to measure mean effects.
MAIN RESULTS
Four studies enrolling 450 participants met our inclusion criteria. Overall risk of bias was judged to be low in one study, unclear in two, and high in one.There was no significant differences in the number of fistulas that were successfully created (4 studies, 433 patients: RR 1.06, 95% CI 0.95 to 1.28; I² = 76%); the number of fistulas that matured at six months (3 studies, 356 participants: RR 1.11, 95% CI 0.98 to 1.25; I² = 0%); number of fistulas that were used successfully for dialysis (2 studies, 286 participants: RR 1.12, 95% CI 0.99 to 1.28; I² = 0%); the number of patients initiating dialysis with a catheter (1 study, 214 patients: RR 0.66, 95% CI 0.42 to 1.04); and in the rate of interventions required to maintain patency (1 study, 70 patients: MD 14.70 interventions/1000 patient-days, 95% CI -7.51 to 36.91) between the use of preoperative imaging technologies compared with standard care (no imaging).
AUTHORS' CONCLUSIONS
Based on four small studies, preoperative vessel imaging did not improve fistula outcomes compared with standard care. Adequately powered prospective studies are required to fully answer this question.
Topics: Adult; Aged; Arteriovenous Shunt, Surgical; Blood Vessels; Humans; Middle Aged; Preoperative Care; Randomized Controlled Trials as Topic; Renal Dialysis; Ultrasonography, Doppler, Color; Vascular Patency
PubMed: 26418347
DOI: 10.1002/14651858.CD007013.pub2 -
International Journal of Colorectal... May 2023Anastomotic leakage after colorectal cancer resection is a feared postoperative complication seen among up till 10-20% of patients, with a higher risk following rectal... (Meta-Analysis)
Meta-Analysis Review
The role of preoperative mechanical bowel preparation and oral antibiotics in prevention of anastomotic leakage following restorative resection for primary rectal cancer - a systematic review and meta-analysis.
PURPOSE
Anastomotic leakage after colorectal cancer resection is a feared postoperative complication seen among up till 10-20% of patients, with a higher risk following rectal resection than colon resection. Recent studies suggest that the combined use of preoperative mechanical bowel preparation and oral antibiotics may have a preventive effect on anastomotic leakage. This systematic review aims to explore the association between preoperative mechanical bowel preparation combined with oral antibiotics and the risk of anastomotic leakage following restorative resection for primary rectal cancer.
METHODS
Three databases were systematically searched in February 2022. Studies reporting anastomotic leakage rate in patients, who received mechanical bowel preparation and oral antibiotics before elective restorative resection for primary rectal cancer, were included. A meta-analysis was conducted based on the risk ratios of anastomotic leakage.
RESULTS
Among 839 studies, 5 studies met the eligibility criteria. The median number of patients were 6111 (80-29,739). The combination of preoperative mechanical bowel preparation and oral antibiotics was associated with a decreased risk of anastomotic leakage (risk ratio = 0.52 (95% confidence interval 0.39-0.69), p-value < 0.001). Limitations included a low number of studies, small sample sizes and the studies being rather heterogenous.
CONCLUSION
This systematic review and meta-analysis found that the use of mechanical bowel preparation and oral antibiotics is associated with a decreased risk of anastomotic leakage among patients undergoing restorative resection for primary rectal cancer. The limitations of the review should be taken into consideration when interpreting the results.
Topics: Humans; Anti-Bacterial Agents; Anastomotic Leak; Surgical Wound Infection; Elective Surgical Procedures; Preoperative Care; Rectal Neoplasms
PubMed: 37184767
DOI: 10.1007/s00384-023-04416-7 -
Neurosurgical Focus Sep 2018OBJECTIVE Despite perioperative risks, epilepsy surgery represents a legitimate curative or palliative treatment approach for children with drug-resistant epilepsy... (Meta-Analysis)
Meta-Analysis
OBJECTIVE Despite perioperative risks, epilepsy surgery represents a legitimate curative or palliative treatment approach for children with drug-resistant epilepsy (DRE). Several factors characterizing infants and toddlers with DRE create unique challenges regarding optimal evaluation and management. Epilepsy surgery within children < 3 years of age has received moderate attention in the literature, including mainly case series and retrospective studies. This article presents a systematic literature review and explores multidisciplinary considerations for the preoperative evaluation and surgical management of infants and toddlers with DRE. METHODS The study team conducted a systematic literature review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, targeting studies that investigated children < 3 years of age undergoing surgical treatment of DRE. Using the PubMed database, investigators selected peer-reviewed articles that reported seizure outcomes with or without developmental outcomes and/or perioperative complications. Studies were eliminated based on the following exclusion criteria: sample size < 5 patients; and inclusion of patients > 3 years of age, when demographic and outcomes data could not be separated from the cohort of patients < 3 years of age. RESULTS The study team identified 20 studies published between January 1990 and May 2017 that satisfied eligibility criteria. All selected studies represented retrospective reviews, observational studies, and uncontrolled case series. The compiled group of studies incorporated 465 patients who underwent resective or disconnective surgery (18 studies, 444 patients) or vagus nerve stimulator insertion (2 studies, 21 patients). Patient age at surgery ranged between 28 days and 36 months, with a mean of 16.8 months (1.4 years). DISCUSSION The study team provided a detailed summary of the literature review, focusing on the etiologies, preoperative evaluation, surgical treatments, seizure and developmental outcomes, and potential for functional recovery of infants and toddlers with DRE. Additionally, the authors discussed special considerations in this vulnerable age group from the perspective of multiple disciplines. CONCLUSIONS While presenting notable challenges, pediatric epilepsy surgery within infants and toddlers (children < 3 years of age) offers significant opportunities for improved seizure frequency, neuro-cognitive development, and quality of life. Successful evaluation and treatment of young children with DRE requires special consideration of multiple aspects related to neurological and physiological immaturity and surgical morbidity.
Topics: Child, Preschool; Disease Management; Drug Resistant Epilepsy; Electroencephalography; Humans; Infant; Neurosurgical Procedures; Observational Studies as Topic; Preoperative Care; Retrospective Studies; Treatment Outcome
PubMed: 30173613
DOI: 10.3171/2018.7.FOCUS18220 -
Medicine Nov 2017A systematic review and meta-analysis of published randomized controlled trials (RCTs) were performed to assess the efficacy and safety of preoperative intravenous... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A systematic review and meta-analysis of published randomized controlled trials (RCTs) were performed to assess the efficacy and safety of preoperative intravenous glucocorticoids versus controls for the prevention of postoperative acute pain and postoperative nausea and vomiting (PONV) after primary total hip arthroplasty (THA).
METHODS
A computer literature search of electronic databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), and China Wanfang database, was conducted to identify the relevant RCTs comparing preoperative intravenous glucocorticoids versus placebos for reducing acute pain and PONV in THA patients. The primary outcomes included the use of the visual analog scale (VAS) with rest or mobilization at 6, 24, 48, and 72 hours and the occurrence of PONV. The secondary outcome was total morphine consumption. We calculated the risk ratio (RR) with a 95% confidence interval (95% CI) for dichotomous outcomes, and the weighted mean difference (WMD) with a 95% CI for continuous outcomes.
RESULTS
Pooled data from 7 RCTs (411 THAs) favored preoperative intravenous glucocorticoids against acute pain intensity at 4, 24, and 48 hours (P < .05). There was no significant difference between the VAS with rest or mobilization at 72 hours (P > .05). Subsequently, preoperative intravenous glucocorticoids provided a total morphine-sparing effect of 9.36 mg (WMD = -9.36, 95% CI = -12.33 to -6.38, P = .000). In addition, preoperative intravenous glucocorticoids were associated with a significant reduction of the occurrence of PONV (RR = 0.41, 95% CI = 0.30-0.57, P = .000).
CONCLUSION
Intravenous glucocorticoids can decrease early pain intensity and PONV after THA. However, the low number of studies and variation in dosing regimens limits the evidence for its use. Thus, more high-quality RCTs are still needed to identify the optimal drug and the safety of intravenous glucocorticoids.
Topics: Administration, Intravenous; Aged; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Female; Glucocorticoids; Humans; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Preoperative Care; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 29381983
DOI: 10.1097/MD.0000000000008804 -
Cancer NursingThe results of previous experimental studies have been inconsistent in the effect of preoperative education on postoperative outcomes, and there have been no... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The results of previous experimental studies have been inconsistent in the effect of preoperative education on postoperative outcomes, and there have been no meta-analyses focusing solely on preoperative education for patients with cancer.
OBJECTIVES
To identify the magnitude and direction of the effects of preoperative education and to investigate the influence of moderators on postoperative outcomes for patients undergoing cancer-related surgery.
METHODS
A systematic review and meta-analysis was conducted following the Cochrane guidelines. Electronic databases were searched until October 2019 using Cochrane database, MEDLINE, EMBASE, and CINAHL for randomized controlled trials and quasi-experimental studies on preoperative education interventions. Ten studies with 45 effect sizes were analyzed in this meta-analysis, and the standardized mean difference was calculated based on Hedges' g as an effect size.
RESULTS
Meta-analysis showed that the overall effect size of preoperative education was moderate. Preoperative education improved cancer patients' knowledge and satisfaction and reduced pain. The effects of preoperative education were greater in younger age groups when delivered using verbal or combined educational methods.
CONCLUSION
This meta-analysis demonstrated the importance of preoperative educational interventions not only in terms of their surgery-related cognitive aspects but also in terms of the physical and psychological aspects linked to the cancer surgery.
IMPLICATIONS FOR PRACTICE
Interventions to provide the most effective preoperative education for patients with cancer in the hospital setting are required, and this information can be used to develop evidence-based education strategies for patients undergoing cancer-related surgery.
Topics: Humans; Neoplasms; Preoperative Care
PubMed: 32769374
DOI: 10.1097/NCC.0000000000000871 -
Journal of Pediatric Psychology Mar 2016To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery. (Review)
Review
OBJECTIVE
To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery.
METHODS
A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children's preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed.
RESULTS
In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies.
CONCLUSIONS
This systematic review suggests that AV interventions can be effective in reducing children's preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice.
Topics: Anxiety; Attention; Audiovisual Aids; Child; Child, Preschool; Elective Surgical Procedures; Female; Humans; Internet; Male; Music Therapy; Play and Playthings; Preoperative Care; Preoperative Period; Randomized Controlled Trials as Topic
PubMed: 26476281
DOI: 10.1093/jpepsy/jsv094