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European Journal of Orthodontics Nov 2023Orthognathic surgical procedures, whether in one or both jaws, can affect structures regarding the articulation and resonance of voice and speech. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Orthognathic surgical procedures, whether in one or both jaws, can affect structures regarding the articulation and resonance of voice and speech.
OBJECTIVE
Evaluating the impact of orthognathic surgery on voice and speech performance in individuals with skeletal dentofacial disharmony.
SEARCH METHODS
Word combinations and truncations were adapted for the following electronic databases: EMBASE, PubMed/Medline, Scopus, Web of Science, Cochrane Library, and Latin American and Caribbean Literature in Health Sciences (LILACS), and grey literature.
SELECTION CRITERIA
The research included studies on nonsyndromic adults with skeletal dentofacial disharmony undergoing orthognathic surgery. These studies assessed patients before and after surgery or compared them with individuals with good facial harmony using voice and speech parameters through validated protocols.
DATA COLLECTION AND ANALYSIS
Two independent reviewers performed all stages of the review. The Joanna Briggs Institute tool was used to assess risk of bias in the cohort studies, and ROBINS-I was used for nonrandomized clinical trials. The authors also performed a meta-analysis of random effects.
RESULTS
A total of 1163 articles were retrieved after the last search, of which 23 were read in full. Of these, four were excluded, totalling 19 articles for quantitative synthesis. When comparing the pre- and postoperative periods, both for fundamental frequency, formants, and jitter and shimmer perturbation measures, orthognathic surgery did not affect vowel production. According to the articles, the main articulatory errors associated with skeletal dentofacial disharmonies prior to surgery were distortions of fricative sounds, mainly/s/ and/z/.
CONCLUSIONS
Orthognathic surgery may have little or no impact on vocal characteristics during vowel production. However, due to the confounding factors involved, estimates are inconclusive. The most prevalent articulatory disorders in the preoperative period were distortion of the fricative phonemes/s/ and/z/. However, further studies must be carried out to ensure greater robustness to these findings.
REGISTRATION
PROSPERO (CRD42022291113).
Topics: Adult; Humans; Orthognathic Surgery; Speech; Orthognathic Surgical Procedures
PubMed: 37467104
DOI: 10.1093/ejo/cjad025 -
Rhinology Dec 2023Identification of perioperative risk factors for recurrent nasal polyps (RNPs) is important for selection of further treatment and determination of appropriate follow-up... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Identification of perioperative risk factors for recurrent nasal polyps (RNPs) is important for selection of further treatment and determination of appropriate follow-up period. However, the relative prognostic significance of these risk factors has not been investigated.
METHODOLOGY
We compared the nasal symptoms, endoscopic polyp and Lund-Mackey computed tomography scores, and the laboratory and pathological findings of RNP and non-RNP patients. The risk of bias was assessed using the Newcastle-Ottawa scale.
RESULTS
Patients with poor nasal symptom scores and olfactory dysfunctions and high Lund-Mackey computed tomography scores were at higher risk of postoperative RNPs, as were those with allergic conditions and elevated tissue and serum eosinophil levels. The tissue neutrophil counts/percentages were significantly lower in the RNP than the other group. The tissue eosinophil level was of higher diagnostic utility than the serum eosinophil level. The RNP diagnostic odds ratio afforded by the tissue eosinophil count or percentage was 54.1247. The area under the receiver operating characteristic curve was 0.936. The sensitivity and specificity were 0.8809 and 0.8834, respectively.
CONCLUSION
The tissue eosinophil level reliably predicts RNP after endoscopic sinus surgery.
Topics: Humans; Nasal Polyps; Rhinitis; Sinusitis; Eosinophils; Smell; Chronic Disease
PubMed: 37453133
DOI: 10.4193/Rhin23.136 -
Diseases of the Esophagus : Official... Oct 2023The aim of this study was to evaluate the effect of intraoperative botulinum toxin (BT) injection on delayed gastric emptying (DGE) and need for endoscopic pyloric... (Meta-Analysis)
Meta-Analysis
Effect of intraoperative botulinum toxin injection on delayed gastric emptying and need for endoscopic pyloric intervention following esophagectomy: a systematic review, meta-analysis, and meta-regression analysis.
The aim of this study was to evaluate the effect of intraoperative botulinum toxin (BT) injection on delayed gastric emptying (DGE) and need for endoscopic pyloric intervention (NEPI) following esophagectomy. In compliance with Preferred Reporting Items for Systematic reviews and Meta-Analyses statement standards, a systematic review of studies reporting the outcomes of intraoperative BT injection in patients undergoing esophagectomy for esophageal cancer was conducted. Proportion meta-analysis model was constructed to quantify the risk of the outcomes and direct comparison meta-analysis model was constructed to compare the outcomes between BT injection and no BT injection or surgical pyloroplasty. Meta-regression was modeled to evaluate the effect of variations in different covariates among the individual studies on overall summary proportions. Nine studies enrolling 1070 patients were included. Pooled analyses showed that the risks of DGE and NEPI following intraoperative BT injection were 13.3% (95% confidence interval [CI]: 7.9-18.6%) and 15.2% (95% CI: 7.9-22.5%), respectively. There was no difference between BT injection and no BT injection in terms of DGE (odds ratio [OR]: 0.57, 95% CI: 0.20-1.61, P = 0.29) and NEPI (OR: 1.73, 95% CI: 0.42-7.12, P = 0.45). Moreover, BT injection was comparable to pyloroplasty in terms of DGE (OR: 0.85, 95% CI: 0.35-2.08, P = 0.73) and NEPI (OR: 8.20, 95% CI: 0.63-105.90, P = 0.11). Meta-regression suggested that male gender was negatively associated with the risk of DGE (coefficient: -0.007, P = 0.003). In conclusion, level 2 evidence suggests that intraoperative BT injection may not improve the risk of DGE and NEPI in patients undergoing esophagectomy. The risk of DGE seems to be higher in females and in early postoperative period. High quality randomized controlled trials with robust statistical power are required for definite conclusions. The results of the current study can be used for hypothesis synthesis and power analysis in future prospective trials.
Topics: Female; Humans; Male; Gastroparesis; Esophagectomy; Pylorus; Botulinum Toxins; Regression Analysis; Gastric Emptying; Postoperative Complications
PubMed: 37539558
DOI: 10.1093/dote/doad053 -
Surgery Dec 2023The benefits of immunonutrition in patients who underwent major abdominal surgery have been recently established, but the optimal combination of immunonutrients has... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The benefits of immunonutrition in patients who underwent major abdominal surgery have been recently established, but the optimal combination of immunonutrients has remained unclear. The aim is to clarify this point.
METHODS
A systematic search of randomized clinical trials about immunonutrition in major abdominal surgery was made. A frequentist random-effects component network meta-analysis was conducted, reporting the P score and odds ratio or mean difference with a 95% confidence interval. The best components and best plausible strategies were described. The critical endpoints were morbidity and mortality rates. The important endpoints were infectious complication rate and length of stay.
RESULTS
The meta-analysis includes 87 studies and 8,375 patients. The best approach for morbidity rate, with a moderate grade of certainty, was the use of perioperative enteral/oral immunonutrition with arginine, glutamine, and polyunsaturated fatty acids (odds ratio 0.32; 0.10 to 0.98; P score of 0.93). The mortality rate was reduced by postoperative enteral immunonutrition with RNA, arginine, and polyunsaturated fatty acids (odds ratio 59; 0.29 to 1.22; P score 0.84) but with a low grade of certainty. No significant heterogeneity or incoherence is observed. The length of stay and infectious results are "at risk" for high heterogeneity or network meta-analysis incoherence. The component analysis confirmed that postoperative oral/enteral use of 2 or 3 components is crucial to reducing morbidity rate.
CONCLUSION
The oral/enteral immunonutrition in the postoperative period, with multiple immunonutrients, can reduce the morbidity rate in patients undergoing major abdominal surgery. The effect of immunonutrition on mortality, infectious disease, and length of stay is unclear.
Topics: Humans; Immunonutrition Diet; Motion Pictures; Abdomen; Arginine; Fatty Acids, Unsaturated
PubMed: 37775395
DOI: 10.1016/j.surg.2023.08.005 -
Patient Education and Counseling Dec 2023To identify and summarize evidence about the benefits of perioperative pain neuroscience education (PNE) on pain-related and psychosocial outcomes. (Review)
Review
OBJECTIVE
To identify and summarize evidence about the benefits of perioperative pain neuroscience education (PNE) on pain-related and psychosocial outcomes.
METHODS
Included were reports written in English that carried out PNE or its synonyms; perioperative period; aged ≥ 18 years; interventional studies and observational studies. Secondary studies, conference abstracts, and editorials were excluded. There was no time limitation.
INFORMATION SOURCES
PubMed, Virtual Health Library, Cochrane Library, and Science Direct. Search: June 20th 2023. The risk of bias was assessed using the Joanna Briggs Institute checklists, and synthesis followed the recommendations of the Synthesis Without Meta-analysis (SWiM) guideline. Register: Center for Open Science website (10.17605/OSF.IO/ZTNEJ).
RESULTS
The sample consisted of 18 reports. For pain outcomes, it was not possible to attribute PNE benefits because ten reports found improvements in both intervention and control groups. For psychosocial outcomes, fourteen reports found benefits for PNE groups. All the analyzed reports showed low risk of bias.
CONCLUSION
PNE had additional benefits beyond those obtained with conventional treatment for psychosocial outcomes.
PRACTICAL IMPLICATIONS
Due to the lack of evidence, it was not possible to indicate the clinical use of PNE. It is suggested that further studies are needed aimed at clarifying the possible benefits.
Topics: Humans; Pain; Neurosciences; Perioperative Period; Pain, Postoperative
PubMed: 37742593
DOI: 10.1016/j.pec.2023.107984 -
Journal of Clinical Medicine Sep 2023The development of prolonged post-operative ileus (POI) remains a significant problem in the general surgical patient population. The aetiology of ileus is poorly... (Review)
Review
BACKGROUND
The development of prolonged post-operative ileus (POI) remains a significant problem in the general surgical patient population. The aetiology of ileus is poorly understood and management options/preventative measures are currently extremely limited. The pathophysiology leading to a post-operative ileus is relatively poorly understood, and there is no validated method to estimate ileus occurrence or duration. Ileus in the post-operative period commonly occurs following major colorectal surgery and leads to painful abdominal distension, vomiting, nutritional deficit, pneumonia, prolonged hospital stays and susceptibility to hospital-acquired infection. An increased hospital stay, the burden of treatment costs and the burden on the health system highlight the importance of future research on finding definitions, preventions and predictions of ileus.
METHODS
A systematic literature review was performed to identify randomized controlled trials (RCTs) comparing the rate of ileus on various treatments for prolonged post-operative ileus following colorectal surgery. A confidence evaluation in a meta-analysis were performed using CINeMA. Direct and indirect comparisons of all interventions were simultaneously carried out using a network meta-analysis. The level of certainty was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The method of assessing the risk of bias, the quality assessment, used the Cochrane Risk of Bias 2 tool (RoB2).
RESULTS
Among the seven included studies, the majority suffered from considerable within-study bias, affecting the confidence rates of study findings. Heterogeneity and incoherence made the pairwise meta-analysis and ranking of interventions unfeasible. Indirect comparisons were considered unreliable due to this incoherence.
CONCLUSIONS
This systematic review, with a confidence evaluation in the network meta-analysis, determined that there is a knowledge gap in the field of study on prolonged ileus following digestive surgery. The current evidence suffers from heterogeneity and incoherence more than imprecision. There is a gap in the data on ileus occurrence in interventional trials for digestive surgery. This could inform clinicians and trialists to better appraise the current literature and plan future trials.
PubMed: 37762711
DOI: 10.3390/jcm12185769 -
International Forum of Allergy &... Mar 2024Endoscopic vidian neurectomy is expected to provide good therapeutic relief in patients with allergic rhinitis (AR) being refractory to medication therapy or... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Endoscopic vidian neurectomy is expected to provide good therapeutic relief in patients with allergic rhinitis (AR) being refractory to medication therapy or conservative surgery. However, the evidence bases for its benefit remain debatable. In this study, we conducted a systematic review and meta-analysis to clarify the therapeutic role of various forms of vidian neurectomy in refractory AR.
METHOD
Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to conduct a systematic review of primary studies that reported original patient data for endoscopic vidian neurectomy (EVN) and vidian-branch neurectomy, which includes selective vidian neurectomy (SVN) and posterior nasal neurectomy (PNN). The primary outcome was patient-reported outcome measures (PROMs), including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Visual Analog Scale (VAS), to assess an improvement in nasal symptom severity and quality of patient's life. The incidence of surgical complications and other objective outcomes were considered secondary outcomes.
RESULTS
This review included 24 clinical studies involving 1677 patients with refractory AR, of which 510 patients in six studies had combined chronic rhinosinusitis with nasal polyps (CRSwNP) and 95 patients in one study had combined asthma. Postoperative PROMs were significantly better than preoperatively in almost all patients who underwent vidianp (RQLQ: standardized mean difference [SMD] = 2.66, 95% confidence interval [CI] = 2.40-2.92, p < 0.001; VAS: SMD = 5.15, 95% CI = 4.29-6.02, p < 0.001) or vidian-branch neurectomy (RQLQ in PNN: SMD = 3.29, 95% CI = 2.45-4.13, p < 0.001; VAS in PNN: SMD = 4.38, 95% CI = 3.41-5.34, p < 0.001), and were generally better than in the conservative treatment group. Dividing with 18 months as the cutoff point, a subgroup analysis of the follow-up period was conducted, and the results showed that both long-term and short-term postoperative patients had considerably reduced symptoms compared to the preoperative period. The two surgical procedures, SVN and PNN, attributed to vidian-branch neurectomy have extremely few complications. However, EVN is more likely to cause dry eyes and palatal numbness, with no other serious complications. In patients with AR and CRSwNP, vidian or selective vidian neurectomy combined with functional endoscopic sinus surgery (FESS) is more effective than conventional FESS (RQLQ: SMD = 2.17, 95% CI = 1.66-2.69, p < 0.001; VAS: SMD = 6.42, 95% CI = 4.78-8.06, p < 0.001). For patients who have both AR and asthma, SVN with pharyngeal branch excision is a potential treatment option.
CONCLUSION
EVN and vidian-branch neurectomy (including SVN and PNN) are effective treatments, but the former has a higher risk of complications. Additionally, vidian-branch neurectomy with FESS is beneficial for patients with mixed CRSwNP. SVN is a potential approach for patients with coexisting AR and asthma.
Topics: Humans; Quality of Life; Rhinitis, Allergic; Denervation; Nose; Asthma; Rhinitis
PubMed: 37715589
DOI: 10.1002/alr.23259 -
BMC Cardiovascular Disorders Mar 2024Postoperative delirium is a common and debilitating complication that significantly affects patients and their families. The purpose of this study is to investigate... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Postoperative delirium is a common and debilitating complication that significantly affects patients and their families. The purpose of this study is to investigate whether there is an effective sedative that can prevent postoperative delirium while also examining the safety of using sedatives during the perioperative period.
METHODS
The net-meta analysis was used to compare the incidence of postoperative delirium among four sedatives: sevoflurane, propofol, dexmedetomidine, and midazolam. Interventions were ranked according to their surface under the cumulative ranking curve (SUCRA).
RESULTS
A total of 41 RCT studies involving 6679 patients were analyzed. Dexmedetomidine can effectively reduce the incidence of postoperative delirium than propofol (OR 0.47 95% CI 0.25-0.90), midazolam (OR 0.42 95% CI 0.17-1.00), normal saline (OR 0.42 95% CI 0.33-0.54) and sevoflurane (OR 0.39 95% CI 0.18-0.82). The saline group showed a significantly lower incidence of bradycardia compared to the group receiving dexmedetomidine (OR 0.55 95% CI 0.37-0.80). In cardiac surgery, midazolam (OR 3.34 95%CI 2.04-5.48) and normal saline (OR 2.27 95%CI 1.17-4.39) had a higher rate of postoperative delirium than dexmedetomidine, while in non-cardiac surgery, normal saline (OR 1.98 95%CI 1.44-2.71) was more susceptible to postoperative delirium than dexmedetomidine.
CONCLUSION
Our analysis suggests that dexmedetomidine is an effective sedative in preventing postoperative delirium whether in cardiac surgery or non-cardiac surgery. The preventive effect of dexmedetomidine on postoperative delirium becomes more apparent with longer surgical and extubation times. However, it should be administered with caution as it was found to be associated with bradycardia.
Topics: Humans; Anesthetics; Bradycardia; Dexmedetomidine; Emergence Delirium; Hypnotics and Sedatives; Midazolam; Propofol; Saline Solution; Sevoflurane; Network Meta-Analysis
PubMed: 38448835
DOI: 10.1186/s12872-024-03783-5 -
Sports Health Dec 2023Knee injury and subsequent surgery are widespread in the military setting. Associations between knee surgery and expected outcomes over time have not been consolidated... (Review)
Review
CONTEXT
Knee injury and subsequent surgery are widespread in the military setting. Associations between knee surgery and expected outcomes over time have not been consolidated and characterized systematically by procedure type across the body of literature, and the temporal expectations of these outcomes remain unclear.
OBJECTIVE
To summarize common postoperative follow-up times and associated outcomes that determine clinical or surgical failure in US service members after elective knee surgery.
DATA SOURCES
A systematic search was conducted with 3 bibliographic databases of published research reports from 2010 through 2021.
STUDY SELECTION
Studies in US military service members undergoing elective knee surgery, with a minimum of 1-year follow-up, and reporting on a functional/occupational outcome were included. Three reviewers screened all abstracts and full-text articles to determine eligibility.
STUDY DESIGN
Systematic review of longitudinal cohort studies.
LEVEL OF EVIDENCE
Level 2a.
DATA EXTRACTION
Extracted data included military demographics, surgical procedure variables, surveillance period, and outcome measures. The Newcastle-Ottawa Scale and the Grading of Recommendations Assessment, Development, and Evaluation approach were used to determine study quality and risk of bias.
RESULTS
A total of 22 studies (mean follow-up time of 40.7 months) met the inclusion criteria. For cruciate ligament repair, approximately one-third of patients required a second surgery or were medically separated from military service by 2 years from surgery; 100% were reinjured by 4 years, and 85% sustained a new injury within 5 years of surgery. For meniscal repair, nearly one-third of patients were medically separated, and half were placed on activity restrictions within 3 years of surgery. For articular cartilage repair, within 5 years, 39% of patients required a second surgery, 30% were placed on activity restrictions, and 36% were medically separated. For patellar repair, 37% of patients were medically separated and over half were placed on activity restrictions within 5 years.
CONCLUSION
Common knee surgeries can have long-term implications for military careers that may not become apparent with shorter follow-up periods (<2 years). When longer surveillance periods are used (eg, up to 5 years), additional surgical procedures are more common and the likelihood of being injured or medically separated from military service is higher.
PubMed: 38148688
DOI: 10.1177/19417381231217449 -
Cureus May 2024Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) represents a minimally invasive alternative to traditional open thyroidectomy (OT). The objective... (Review)
Review
Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) represents a minimally invasive alternative to traditional open thyroidectomy (OT). The objective of this systematic review and meta-analysis was to comprehensively analyze and compare postoperative pain outcomes between conventional open thyroidectomy (COT) and TOETVA. We conducted a systematic search across multiple databases, including PubMed, Medline, Elton B. Stephens Company (EBSCO), and Google Scholar, to identify cohorts and randomized trials comparing postoperative pain outcomes between patients undergoing transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) and those undergoing conventional thyroidectomy. The search period spanned from the earliest available article up to January 15, 2022. Keywords such as "scarless thyroidectomy," "endoscopic transoral via vestibular thyroidectomy," "conventional thyroidectomy," "transcervical thyroidectomy," "postoperative pain," and "visual analog pain score" were utilized to retrieve relevant studies. A total of 1,291 patients from 11 studies were included in our analysis, with 10 studies originating from Asia and one from Europe. Among these studies, seven were prospective, while four were retrospective. The primary outcome measure was postoperative pain. Various statistical tests were also performed for data analysis, including the Chi-square and random effects model. The Newcastle Ottawa Scale was used to assess the quality of studies. There was no significant statistical difference observed between the endoscopic transoral vestibular route and the conventional cervical approach in terms of visual analog scale (VAS) score, with an odds ratio of -0.37 and a 95% confidence interval ranging from -0.9 to 0.17. The overall effect had a P-value of 0.18. However, substantial heterogeneity was noted, with an I2 value for heterogeneity of 98% and a P-value for heterogeneity of less than 0.001. The Chi-square value was calculated as 364.02, and the main difference was 9. In comparison, TOETVA exhibited lower pain levels on the first day post-operation compared to conventional thyroidectomy, with an odds ratio of -1.36 and a 95% confidence interval ranging from -2.65 to -0.06. Transoral endoscopic thyroidectomy via the vestibular approach demonstrated superior outcomes compared to conventional thyroidectomy in terms of postoperative pain management on the first day following surgery. However, when considering overall pain management throughout the recovery period, no significant difference was observed between the two approaches. More extensive studies evaluating pain levels on the day of surgery and controlling for analgesic interventions are warranted.
PubMed: 38854204
DOI: 10.7759/cureus.59998