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Journal of Cachexia, Sarcopenia and... Jun 2020Sarcopenia might function as an indicator for frailty, and as such as a risk factor for the development of postoperative complications. The aim of this study was to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sarcopenia might function as an indicator for frailty, and as such as a risk factor for the development of postoperative complications. The aim of this study was to meta-analyse the relation between preoperative sarcopenia and the development of severe postoperative complications in patients undergoing oncological surgery.
METHODS
PubMed and Embase databases were systematically searched from inception until May 2018. Included were studies reporting on the incidence of severe postoperative complications and radiologically determined preoperative sarcopenia. Studies reporting the skeletal muscle as a continuous variable only were excluded. Data were extracted independently by two reviewers. Random effect meta-analyses were applied to estimate the pooled odds ratio (OR) with 95% confidence intervals (95% CI) for severe postoperative complications, defined as Clavien-Dindo grade ≥3, including 30-day mortality. Heterogeneity was evaluated with I testing. Analyses were performed overall and stratified by measurement method, tumour location and publication date.
RESULTS
A total of 1924 citations were identified, and 53 studies (14 295 patients) were included in the meta-analysis. When measuring the total skeletal muscle area, 43% of the patients were sarcopenic, versus 33% when measuring the psoas area. Severe postoperative complications were present in 20%, and 30-day mortality was 3%. Preoperative sarcopenia was associated with an increased risk of severe postoperative complications (OR : 1.44, 95% CI: 1.24-16.8, P<0.001, I =55%) and 30-day mortality (OR : 2.15, 95% CI: 1.46-3.17, P<0.001, I =14%). A low psoas mass was a stronger predictor for severe postoperative complications compared with a low total skeletal muscle mass (OR : 2.06, 95% CI: 1.37-3.09, OR : 1.32, 95% CI: 1.14-1.53, respectively) and 30-day mortality [OR : 6.17 (95% CI: 2.71-14.08, OR : 1.80 (95% CI: 1.24-2.62), respectively]. The effect was independent of tumour location and publication date.
CONCLUSIONS
The presence of low psoas mass prior to surgery, as an indicator for sarcopenia, is a common phenomenon and is a strong predictor for the development of postoperative complications. The presence of low total skeletal muscle mass, which is even more frequent, is a less informative predictor for postoperative complications and 30-day mortality. The low heterogeneity indicates that the finding is consistent over studies. Nevertheless, the value of sarcopenia relative to other assessments such as frailty screening is not clear. Research is needed in order to determine the place of sarcopenia in future preoperative risk stratification.
Topics: Aged; Humans; Morbidity; Muscle, Skeletal; Postoperative Period; Sarcopenia; Surgical Oncology
PubMed: 32125769
DOI: 10.1002/jcsm.12529 -
European Spine Journal : Official... Oct 2022Significant risk of injury to the lumbar plexus and its departing motor and sensory nerves exists with lateral lumbar interbody fusion (LLIF). Several cadaveric and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Significant risk of injury to the lumbar plexus and its departing motor and sensory nerves exists with lateral lumbar interbody fusion (LLIF). Several cadaveric and imaging studies have investigated the lumbar plexus position with respect to the vertebral body anteroposterior plane. To date, no systematic review and meta-analysis of the lumbar plexus safe working zones for LLIF has been performed.
METHODS
This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Relevant studies reporting on the position of the lumbar plexus with relation to the vertebral body in the anteroposterior plane were identified from a PubMed database query. Quantitative analysis was performed using Welch's t test.
RESULTS
Eighteen studies were included, encompassing 1005 subjects and 2472 intervertebral levels. Eleven studies used supine magnetic resonance imaging (MRI) with in vivo subjects. Seven studies used cadavers, five of which performed dissection in the left lateral decubitus position. A significant correlation (p < 0.001) existed between anterior lumbar plexus displacement and evaluation with in vivo MRI at all levels between L1-L5 compared with cadaveric measurement. Supine position was also associated with significant (p < 0.001) anterior shift of the lumbar plexus at all levels between L1-L5.
CONCLUSIONS
This is the first comprehensive systematic review and meta-analysis of the lumbar neural components and safe working zones for LLIF. Our analysis suggests that the lumbar plexus is significantly displaced ventrally with the supine compared to lateral decubitus position, and that MRI may overestimate ventral encroachment of lumbar plexus.
Topics: Cadaver; Humans; Lumbar Vertebrae; Lumbosacral Plexus; Psoas Muscles; Spinal Fusion
PubMed: 35984508
DOI: 10.1007/s00586-022-07352-2 -
Frontiers in Endocrinology 2022Recently, the effects of paraspinal muscle degeneration on osteoporotic vertebral fractures (OVFs) have attracted the attention of researchers; however, studies are... (Meta-Analysis)
Meta-Analysis
PURPOSE
Recently, the effects of paraspinal muscle degeneration on osteoporotic vertebral fractures (OVFs) have attracted the attention of researchers; however, studies are limited, and their results vary. Hence, this study aimed to determine the role of paraspinal muscle degeneration in the occurrence and recurrence of OVF.
METHODS
Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline, the PubMed, Embase, Web of Science, Wanfang Data, China National Knowledge Infrastructure, and ClinicalTrials.gov databases were comprehensively searched for relevant studies. Studies comparing the cross-sectional area (CSA) or fatty infiltration (FI) of the paraspinal muscles (including the psoas (PS), erector spinae plus multifidus (ES+MF), quadratus lumborum) in patients with and without initial OVF, or with and without recurrent OVF were included and analyzed.
RESULTS
Eleven studies were included in the meta-analysis. Seven studies investigated the effects of paraspinal muscles on initial OVF, and the overall results revealed significantly lower CSA (SMD: -0.575, 95% CI: -0.866 to -0.285) and CSA (SMD: -0.750, 95% CI: -1.274 to -0.226), and higher FI (SMD: 0.768, 95% CI: 0.475 to 1.062) in the fracture group. Meanwhile, four studies evaluated the effects of the paraspinal muscles on recurrent OVF, and the pooled results demonstrated significantly higher FI (SMD:0.720, 95% CI: 0.258 to 1.182) in the refracture group, although no significant difference in CSA (SMD: -0.103, 95% CI: -0.395 to 0.189) was observed between the two groups.
CONCLUSIONS
Paraspinal muscle degeneration plays a role in the occurrence and recurrence of OVF. Assessing the paraspinal muscles may be useful for identifying high-risk populations.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier (CRD42021276681).
Topics: Humans; Spinal Fractures; Paraspinal Muscles; Lumbar Vertebrae; Retrospective Studies; Magnetic Resonance Imaging; Osteoporotic Fractures; Muscular Atrophy
PubMed: 36686478
DOI: 10.3389/fendo.2022.1073013 -
European Journal of Orthopaedic Surgery... Jan 2023Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
Historically, posterior approaches to the lumbar spine have allowed surgeons to manage degenerative conditions affecting the lumbar spine. However, spinal muscles injury, post-surgical vertebral instability, cerebrospinal fluid (CSF) leakage, and failed back surgery syndrome (FBSS) represent severe complications that may occur after these surgeries. Lumbar interbody fusion using anterior (ALIF), oblique (OLIF), or lateral (LLIF) approaches may represent valuable surgical alternatives, in case fusion is indicated on single or multiple levels.
METHODS
The present study is a systematic review, conducted according to the PRISMA statement, of comparative studies on OLIF, and LLIF for degenerative spine disorders, and a meta-analysis of their clinical-radiological outcomes and complications.
RESULTS
After screening 1472 papers on PubMed, Scopus, and Cochrane Library, only 3 papers were included in the present study. 318 patients were included for data meta-analysis, 128 in OLIF group, and 190 in LLIF group. There were no significative differences in terms of surgical (intraoperative blood loss and surgical duration) and clinical (VAS-back, VAS-leg, and ODI scores) outcomes, or fusion rates at last follow-up (> 2 years). Significantly higher rates of abdominal complications, system failure, and vascular injuries were recorded in the OLIF group. Conversely, postoperative neurological symptoms and psoas weakness were significatively more common in LLIF group.
CONCLUSIONS
The meta-analysis suggests that OLIF and LLIF are both effective for lumbar degenerative disorders, although each of them presents specific complications and this should represent a relevant element in the surgical planning.
Topics: Humans; Spinal Fusion; Spinal Diseases; Lumbar Vertebrae; Blood Loss, Surgical; Surgeons; Retrospective Studies; Treatment Outcome
PubMed: 34825987
DOI: 10.1007/s00590-021-03172-0 -
Annals of Nutrition & Metabolism 2021The aim of this study is to investigate the association between loss of muscle mass and prognosis of sepsis. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The aim of this study is to investigate the association between loss of muscle mass and prognosis of sepsis.
METHODS
Six databases, including PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Ovid, were searched by the deadline of August 18, 2020. A meta-analysis was conducted on the collected data by means of a random-effects model. The quality of each included article was assessed according to the Newcastle-Ottawa Scale.
RESULTS
Out of 1,819 references, 6 articles and 1 conference abstract were included. Sepsis patients with a loss of muscle mass or sarcopenia had higher mortality (risk ratio [RR]: 1.94, 95% confidence intervals [CI]: 1.59-2.37; I-squared = 18.7%, p < 0.001). The RR of mortality within 30 days (RR: 2.31, 95% CI: 1.78-2.99, p < 0.001) was higher than that of mortality over 30 days. Loss of psoas muscle mass, as evaluated by CT, showed the highest RR of sepsis mortality. In addition, based on data on overall survival retrieved from 4 trials, the pooled hazard ratio (HR) for patients with a loss of muscle mass or sarcopenia was 3.04. Subgroup analysis showed that survival time was the main source of heterogeneity for the overall HR. Furthermore, the scanning areas of muscle mass in survival patients were 0.33 cm2/m2 higher than those measured in deceased patients.
CONCLUSION
A loss of muscle mass, as evaluated by CT scan, was associated with a poor outcome in sepsis.
Topics: Humans; Muscles; Prognosis; Sarcopenia; Sepsis; Tomography, X-Ray Computed
PubMed: 34657039
DOI: 10.1159/000519642 -
Markers of sarcopenia increase 30-day mortality following emergency laparotomy: A systematic review.Scandinavian Journal of Surgery : SJS :... Mar 2023Decreased skeletal muscle mass and quality are one of the several markers used for sarcopenia diagnosis and are generally associated with increased rates of... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVE
Decreased skeletal muscle mass and quality are one of the several markers used for sarcopenia diagnosis and are generally associated with increased rates of post-operative infections, poorer recovery and increased mortality. The aim of this review was to evaluate methods applied to detect markers of sarcopenia and the associated outcomes for patients undergoing emergency laparotomy.
METHODS
This review was conducted with reference to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. MEDLINE, Embase and Google Scholar databases were searched. Studies detecting patients with sarcopenia or skeletal muscle decline markers and the associated outcomes after emergency laparotomy surgery were considered. The Newcastle-Ottawa Scale was used to evaluate publication quality.
RESULTS
Out of 103 studies, which were screened, 19 full-text records were reviewed and 7 studies were ultimately analyzed. The study cohort sizes ranged from = 46 to = 967. The age range was 36-95 years. There were 1107 females (53%) and 973 males (47%) across all 7 studies. All studies measured psoas muscle mass and three studies assessed psoas muscle quality using computerized tomography (CT) imaging. No study assessed muscle strength or function, while five studies showed an association between low muscle mass and increased mortality rates after emergency laparotomy. Among the three studies, which assessed muscle quality, two of three studies showed poorer 30-day survival rates.
CONCLUSIONS
The existing literature is limited, however it indicates that low psoas muscle mass and quality markers are associated with increased 30-day mortality rates after emergency laparotomy. Therefore, muscle markers can be used as a new feasible tool to identify most at risk patients requiring further interventions.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Laparotomy; Muscle Strength; Muscle, Skeletal; Sarcopenia; Survival Rate
PubMed: 36348615
DOI: 10.1177/14574969221133198 -
Journal of Vascular Surgery Nov 2022The primary objectives of our scoping review were to evaluate the methods used by research groups to assess the incidence of sarcopenia in patients with aortic disease... (Review)
Review
OBJECTIVE
The primary objectives of our scoping review were to evaluate the methods used by research groups to assess the incidence of sarcopenia in patients with aortic disease and the extent of the evidence base that links sarcopenia to the survival of patients undergoing elective endovascular aortic repair and to identify the recurring themes or gaps in the literature to guide future research.
METHODS
A scoping review in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) protocols extension for scoping reviews was performed. The available studies included those fully reported in English (last query, April 30, 2022). The following PICO question was used to build the search equation: "in patients with aortic disease [population] undergoing endovascular repair [intervention], what was the prevalence and prognosis of radiologically defined sarcopenia [comparison] on the short- and long-term outcomes?"
RESULTS
A total of 31 studies were considered relevant, and 18 were included in the present scoping review. In brief, 12 studies had focused on standard endovascular aneurysm repair (EVAR), 2 on thoracic EVAR, and 4 on complex EVAR. All but two studies were retrospective in design, and only one study had included patients from a multicenter database. Sarcopenia had generally been defined using the computed tomography angiography (CTA) findings of the cross-sectional area of the psoas muscle at L3 or L4, sometimes with normalization against the height. Overall, despite the heterogeneity in the methods used for its definition, sarcopenia was highly prevalent (range, 12.5%-67.6%). The patients with sarcopenia had had higher rates of mortality (ratio ranged from 2.28 [95% confidence interval, 1.35-3.84] to 6.34 [95% confidence interval, 3.37-10.0]) and adverse events (41% vs 16%; P = .020).
CONCLUSIONS
Sarcopenia, as identified using computed tomography angiography-based measurements of the skeletal muscle mass, was prevalent among patients undergoing elective EVAR, thoracic EVAR, or complex EVAR. The presence of sarcopenia has been shown to have a negative prognostic impact, increasing the operative risk and has been linked to poorer long-term survival.
Topics: Humans; Sarcopenia; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Prognosis; Retrospective Studies; Risk Factors; Treatment Outcome; Psoas Muscles; Risk Assessment; Multicenter Studies as Topic
PubMed: 35667604
DOI: 10.1016/j.jvs.2022.05.005 -
International Journal of Gynecological... May 2020Muscle mass plays a key role in predicting clinical outcomes in cancer. This systematic review and meta-analysis aimed to evaluate whether computed tomography (CT) scan... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Muscle mass plays a key role in predicting clinical outcomes in cancer. This systematic review and meta-analysis aimed to evaluate whether computed tomography (CT) scan indexes of muscle mass quantity and quality could be used as prognostic factors in ovarian cancer.
METHODS
Three electronic bibliographic databases (MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials) were used to conduct a systematic literature search from inception to January 2020. The primary outcome was overall survival. Pooled analyses of hazard ratios (HRs) and 95% confidence intervals (CIs) were performed with Review Manager 5.3. Heterogeneity was assessed by measuring inconsistency (I based on the χ test). Secondary outcomes included progression free survival, disease free survival, postoperative complications, and chemotoxicity. Study quality and quality of evidence were assessed.
RESULTS
A total of 15 studies were included in the systematic review, of which six studies (1226 patients) were included in the meta-analysis. Summary unadjusted HRs (HR 1.11, 95% CI 0.84 to 1.46, p=0.47) and adjusted HRs (HR 1.10, 95% CI 0.84 to 1.43, p=0.49) did not show a significant association between low skeletal muscle index and overall survival (p>0.05) in ovarian cancer. Instead, although the quality of evidence was low, pooled data of three studies, comprising 679 patients, showed a significant association between low skeletal muscle radiodensity and poor overall survival (HR 1.63, 95% CI 1.28 to 2.07, p<0.0001). Moreover, the heterogeneity between studies precluded the possibility of performing a meta-analysis and reaching conclusions for progression free survival, disease free survival, surgical complications, and chemotoxicity.
CONCLUSIONS
This work suggested that the measurement of skeletal muscle radiodensity by routine CT scan at diagnosis, with standardization of diagnostic criteria, could be a reliable tool to select at risk patients and to individualize effective nutritional strategies. However, prospective homogeneous studies with a larger number of patients are required to confirm these results.
Topics: Databases, Bibliographic; Female; Humans; Muscle, Skeletal; Ovarian Neoplasms; Prognosis; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32241875
DOI: 10.1136/ijgc-2020-001215 -
Clinical Spine Surgery Aug 2020Systematic review and meta-analysis. (Comparative Study)
Comparative Study Meta-Analysis
A Comparison of Complications and Clinical and Radiologic Outcome Between the Mini-open Prepsoas and Mini-open Transpsoas Approaches for Lumbar Interbody Fusion: A Meta-Analysis.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To compare complication rates and clinical and radiologic outcome between the mini-open prepsoas and mini-open transpsoas approaches for lateral lumbar interbody fusion.
SUMMARY OF BACKGROUND DATA
Both approaches are believed to be safe with similar complication rates. Previous studies suggest that the rate of neurological injury might be higher in the transpsoas group, whereas visceral or vascular injury might be more frequent in the prepsoas group.
METHODS
A systematic review of the literature was performed. Data were extracted from original publications up until December 26, 2018. Evidence was extracted from well-designed case-control or cohort studies and sorted in 2 groups, the prepsoas and transpsoas approaches. A meta-analysis was performed using a random-effects model (I statistic >50% for all analyses).
RESULTS
A total of 115 studies included data of 13,260 patients, 2450 in the prepsoas group and 10,810 in the transpsoas group. Demographics for prepsoas versus transpsoas group were (N-weighted means): age 61.9 versus 60.9 years; %female sex 53% versus 63%, levels fused 1.4 versus 2.6, blood loss 52.4 versus 122.3 mL, and operating time 125.1 versus 200.7 min. The following statistically significant differences in complication rates between prepsoas and transpsoas approaches were found: transient psoas weakness or thigh/groin numbness 4% versus 26% [95% confidence interval (CI): 11%-17%], motor neural injury 0.4% versus 1.3% (95% CI: 16%-62.3%); no statistically significant differences were found for: major vascular injury 2% versus 1% (95% CI: 1.04%-2.31%), kidney or ureter injury 0.04% versus 0.08% (95% CI: 0.057%-5.2%), injury pleural/peritoneal structures 0.6% versus 0.2% (95% CI: 0.89%-6.58%), cage subsidence 5% versus 4% (95% CI: 0.9%-1.97%), surgical site infection 1% versus 1% (95% CI: 0.57%-1.66%), abdominal wall pseudohernia 1% versus 1% (95% CI: 0.07%-21.22%), sympathetic chain injury 5% versus 0% (95% CI: 0.34%-97.86%), and directly procedure-related death 0.04% versus 0% (95% CI: 0.127%-76.8%). Pooled mean perioperative changes between prepsoas and transpsoas approaches were: segmental sagittal Cobb angle 3.07 versus 1.99 degrees; foraminal height 2 versus 6.96 mm.
CONCLUSIONS
The prepsoas had fewer complications than the transpsoas approach. Furthermore, the prepsoas approach showed superior restoration of segmental lordosis, whereas foraminal height restoration was superior with the transpsoas approach. This could be explained by the differences in location of the interbody device placement in relation to the center of rotation of the spine between the 2 surgical techniques.
Topics: Humans; Intervertebral Disc Degeneration; Lumbar Vertebrae; Operative Time; Postoperative Complications; Psoas Muscles; Spinal Fusion
PubMed: 32482972
DOI: 10.1097/BSD.0000000000001015 -
Journal of Hip Preservation Surgery Jan 2024Arthroscopic iliopsoas fractional lengthening (IFL) is a surgical option for the treatment of internal snapping hip syndrome (ISHS) after failing conservative... (Review)
Review
Arthroscopic iliopsoas fractional lengthening (IFL) is a surgical option for the treatment of internal snapping hip syndrome (ISHS) after failing conservative management. Systematic review. A search of PubMed central, National Library of Medicine (MEDLINE) and Scopus databases were performed by two individuals from the date of inception to April 2023. Inclusion criteria were ISHS treated with arthroscopy. Sample size, patient-reported outcomes and complications were recorded for 24 selected papers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and registered on PROSPERO database for systematic reviews (CRD42023427466). Thirteen retrospective case series, ten retrospective comparative studies, and one randomized control trial from 2005 to 2022 were reported on 1021 patients who received an iliopsoas fractional lengthening. The extracted data included patient satisfaction, visual analogue scale, the modified Harris hip score and additional outcome measures. All 24 papers reported statistically significant improvements in post-operative patient-reported outcome measures after primary hip arthroscopy and iliopsoas fractional lengthening. However, none of the comparative studies found a statistical benefit in performing IFL. Existing studies lack conclusive evidence on the benefits of Iliopsoas Fractional Lengthening (IFL), especially for competitive athletes, individuals with Femoroacetabular Impingement (FAI), and borderline hip dysplasia. Some research suggests IFL may be a safe addition to hip arthroscopy for Internal Snapping Hip Syndrome, but more comprehensive investigations are needed. Future studies should distinguish between concurrent procedures and develop methods to determine if the psoas muscle is the source of pain, instead of solely attributing it to the joint.
PubMed: 38606331
DOI: 10.1093/jhps/hnad039