scholarly journals Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Davide Reale ◽  
Luca Andriolo ◽  
Safa Gursoy ◽  
Murat Bozkurt ◽  
Giuseppe Filardo ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Surgical Procedures ◽  
Lower Limb ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Orthopedic Procedures ◽  
Cochrane Library ◽  
Complication Rates ◽  
Administration Route ◽  
Orthopedic Surgical Procedures

Objective. Tranexamic acid (TXA) is increasingly used in orthopedic surgery to reduce blood loss; however, there are concerns about the risk of venous thromboembolic (VTE) complications. The aim of this study was to evaluate TXA safety in patients undergoing lower limb orthopedic surgical procedures. Design. A meta-analysis was performed on the PubMed, Web of Science, and Cochrane Library databases in January 2020 using the following string (Tranexamic acid) AND ((knee) OR (hip) OR (ankle) OR (lower limb)) to identify RCTs about TXA use in patients undergoing every kind of lower limb surgical orthopedic procedures, with IV, IA, or oral administration, and compared with a control arm to quantify the VTE complication rates. Results. A total of 140 articles documenting 9,067 patients receiving TXA were identified. Specifically, 82 studies focused on TKA, 41 on THA, and 17 on other surgeries, including anterior cruciate ligament reconstruction, intertrochanteric fractures, and meniscectomies. The intravenous TXA administration protocol was studied in 111 articles, the intra-articular in 45, and the oral one in 7 articles. No differences in terms of thromboembolic complications were detected between the TXA and control groups neither in the overall population (2.4% and 2.8%, respectively) nor in any subgroup based on the surgical procedure and TXA administration route. Conclusions. There is an increasing interest in TXA use, which has been recently broadened from the most common joint replacement procedures to the other types of surgeries. Overall, TXA did not increase the risk of VTE complications, regardless of the administration route, thus supporting the safety of using TXA for lower limb orthopedic surgical procedures.

scholarly journals Bioaersols in orthopedic surgical procedures and implications for clinical practice in the times of COVID-19 pandemic: a protocol for systematic review and meta-analysis

2020 ◽  
Author(s):  
Siddhartha Sharma ◽  
Rakesh John ◽  
Deepak Neradi ◽  
Sandeep Patel ◽  
Mandeep Singh Dhillon
Keyword(s):  
Systematic Review ◽  
Surgical Procedures ◽  
Meta Analysis ◽  
Operating Rooms ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Occupational Risk Factors ◽  
Aerosol Generation ◽  
Orthopedic Surgical Procedures ◽  
Power Tools

Background Orthopedic surgical procedures involve a number of aerosol generating procedures; these include electrocautery, power instruments for bone cutting, burring and drilling, and tools for wound lavage. This assumes a great significance in the context of the current COVD-19 pandemic, as there are chances of aerosol-borne disease transmission in orthopedic surgical procedures. Hence, this systematic review and meta-analysis will be undertaken to assimilate and analyse the available evidence on bioaerosols in orthopedic surgical procedures and their significance with respect to SARS-CoV-2 virus transmission. Objectives To determine the characteristics (amount and/or density, size, infectivity, and spread etc.) of bioaerosols found in orthopaedic operating rooms (ORs) and to determine the characteristics of aerosols generated by different orthopaedic power tools and devices. Methods A systematic review and meta-analysis will be conducted. The PRISMA guidelines will be strictly followed. The primary search will be conducted on the PubMed, EMBASE, Scopus, Cochrane Library, medRxiv, bioRxix and Lancet preprint databases, using a well-defined search strategy. Any original research study (including cohort, case-control, case series, cadaveric studies and studies, animal models, laboratory based experimental studies) looking at aerosol generation in orthopedic surgical procedures, or aerosol generation by orthopaedic power tools and devices will included. Outcome measures will include characteristics (amount and/or density, size, infectivity, and spread etc.) of bioaerosols found in orthopaedic operating rooms (ORs) and those generated by various orthopaedics power tools and devices. Metanalysis using the random-effects model will be conducted to determined pooled estimates of the outcome variables. Heterogeneity will be assessed by the I2 test. Risk of bias will be assessed by the Risk of Bias in Studies estimating Prevalence of Exposure to Occupational risk factors (RoB-SPEO) tool. The overall strength of evidence will be assessed by the GRADE approach.

scholarly journals Effect of tranexamic acid in arthroscopic anterior cruciate ligament repair: A systematic review and meta-analysis of randomised clinical trials

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110173
Author(s):  
Tze Khiang Tan ◽  
Ka Ting Ng ◽  
Hui Jane Lim ◽  
Ross Radic
Keyword(s):  
Clinical Trials ◽  
Anterior Cruciate Ligament ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Lysholm Score ◽  
Randomised Clinical Trials ◽  
Postoperative Blood Loss ◽  
Anterior Cruciate

Purpose: Perioperative blood loss remains a major challenge to surgeons in anterior cruciate ligament reconstruction (ACLR) surgery, despite of the introduction of minimally invasive approach. Tranexamic acid (TXA) is believed to reduce blood loss, which may minimise the complication of postoperative haemarthrosis with insufficient evidence on its effectiveness in ACLR. The primary aim of this study was to examine the effect of TXA on postoperative blood loss and other secondary outcomes in patients undergoing arthroscopic ACLR surgery. Method: PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched from its inception until November 2020. All randomised clinical trials (RCTs) comparing TXA (intravenous or intra-articular) versus placebo in the arthroscopic ACLR surgery were included. Case series, case report and editorials were excluded. Results: Five RCTs comprising of a total of 580 patients (291 in TXA group, 289 in control group) were included for qualitative and quantitative meta-analysis. In comparison to placebo, TXA group was significantly associated with lower postoperative blood loss (mean difference (MD): −81.93 ml; 95% CI −141.80 to −22.05) and lower incidence of needing knee aspiration (odd ratio (OR): 0.19; 95% CI 0.08 to 0.44). Patients who randomised to TXA were also reported to have better range of movement (MD: 2.86; 95% CI 0.54 to 5.18), lower VAS Pain Score (MD: −1.39; 95% CI −2.54 to −0.25) and higher Lysholm Score (MD: 7.38; 95% CI 2.75 to 12.01). Conclusion: In this meta-analysis, TXA reduced postoperative blood loss with lesser incidence of needing knee aspiration along with better range of knee movement and Lysholm score in patients undergoing arthroscopic ACLR surgery.

scholarly journals Endoscopic versus Surgical Intervention for Painful Obstructive Chronic Pancreatitis: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (12) ◽  
pp. 2636
Author(s):  
Ka Wing Ma ◽  
Hoonsub So ◽  
Euisoo Shin ◽  
Janice Hoi Man Mok ◽  
Kim Ho Kam Yuen ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Meta Analysis ◽  
Small Sample ◽  
Cochrane Library ◽  
Endoscopic Drainage ◽  
Complication Rates ◽  
Surgical Drainage ◽  
Endocrine Insufficiency ◽  
Significant Difference

There is limited evidence on the standard care for painful obstructive chronic pancreatitis (CP), while comparisons of endoscopic and surgical modes for pain relief have yielded conflicting results from small sample sizes. We aimed to obtain a clear picture of the matter by a meta-analysis of these results. We searched the Pubmed, Embase, and Cochrane Library databases to identify studies comparing endoscopic and surgical treatments for painful obstructive CP. Pooled effects were calculated by the random effect model. Primary outcomes were overall pain relief (complete and partial), and secondary outcomes were complete and partial pain relief, complication rate, hospitalization duration, and endocrine insufficiency. Seven studies with 570 patients were included in the final analysis. Surgical drainage was associated with superior overall pain relief [OR 0.33, 95% CI 0.23–0.47, p < 0.001, I2 = 4%] and lesser incidence of endocrine insufficiency [OR 2.10, 95% CI 1.20–3.67, p = 0.01, I2 = 0%], but no significant difference in the subgroup of complete [OR 0.57, 95% CI 0.32–1.01, p = 0.054, I2 = 0%] or partial [OR 0.67, 95% CI 0.37–1.22, p = 0.19, I2 = 0%] pain relief, complication rates [OR 1.00, 95% CI 0.41–2.46, p = 0.99, I2 = 49%], and hospital stay [OR −0.54, 95% CI −1.23–0.15, p = 0.13, I2 = 87%] was found. Surgery is associated with significantly better overall pain relief and lesser endocrine insufficiency in patients with painful obstructive CP. However, considering the invasiveness of surgery, no significant differences in complete or partial pain relief, and heterogeneity of a few parameters between two groups, endoscopic drainage may be firstly performed and surgical drainage may be considered when endoscopic drainage fails.

scholarly journals Perioperative goal-directed therapy and postoperative complications in different kind of surgical procedures: an updated meta-analysis

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Mariateresa Giglio ◽  
Giandomenico Biancofiore ◽  
Alberto Corriero ◽  
Stefano Romagnoli ◽  
Luigi Tritapepe ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Meta Analysis ◽  
Orthopedic Procedures ◽  
Neurosurgical Procedures ◽  
Goal Directed Therapy ◽  
Number Of Patients ◽  
Risk Patients

Abstract Background Goal-directed therapy (GDT) aims to assure tissue perfusion, by optimizing doses and timing of fluids, inotropes, and vasopressors, through monitoring of cardiac output and other basic hemodynamic parameters. Several meta-analyses confirm that GDT can reduce postoperative complications. However, all recent evidences focused on high-risk patients and on major abdominal surgery. Objectives The aim of the present meta-analysis is to investigate the effect of GDT on postoperative complications (defined as number of patients with a least one postoperative complication) in different kind of surgical procedures. Data sources Randomized controlled trials (RCTs) on perioperative GDT in adult surgical patients were included. The primary outcome measure was complications, defined as number of patients with at least one postoperative complication. A subgroup-analysis was performed considering the kind of surgery: major abdominal (including also major vascular), only vascular, only orthopedic surgery. and so on. Study appraisal and synthesis methods Meta-analytic techniques (analysis software RevMan, version 5.3.5, Cochrane Collaboration, Oxford, England, UK) were used to combine studies using odds ratios (ORs) and 95% confidence intervals (CIs). Results In 52 RCTs, 6325 patients were enrolled. Of these, 3162 were randomized to perioperative GDT and 3153 were randomized to control. In the overall population, 2836 patients developed at least one complication: 1278 (40%) were randomized to perioperative GDT, and 1558 (49%) were randomized to control. Pooled OR was 0.60 and 95% CI was 0.49–0.72. The sensitivity analysis confirmed the main result. The analysis enrolling major abdominal patients showed a significant result (OR 0.72, 95% CI 0.59–0.87, p = 0.0007, 31 RCTs, 4203 patients), both in high- and low-risk patients. A significant effect was observed in those RCTs enrolling exclusively orthopedic procedures (OR 0.53, 95% CI 0.35–0.80, p = 0.002, 7 RCTs, 650 patients. Also neurosurgical procedures seemed to benefit from GDT (OR 0.40, 95% CI 0.21–0.78, p = 0.008, 2 RCTs, 208 patients). In both major abdominal and orthopedic surgery, a strategy adopting fluids and inotropes yielded significant results. The total volume of fluid was not significantly different between the GDT and the control group. Conclusions and implications of key findings The present meta-analysis, within the limits of the existing data, the clinical and statistical heterogeneity, suggests that GDT can reduce postoperative complication rate. Moreover, the beneficial effect of GDT on postoperative morbidity is significant on major abdominal, orthopedic and neurosurgical procedures. Several well-designed RCTs are needed to further explore the effect of GDT in different kind of surgeries.

Abstract 14948: Comparative Effectiveness of CRT in Older Patients With Heart Failure: Systematic Review and Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Saeed Juggan ◽  
Clifford A Reilly ◽  
Praveen K Ponnamreddy ◽  
Lauren Gilstrap ◽  
Emily Zeitler
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Comparative Effectiveness ◽  
Older Patients ◽  
Meta Analysis ◽  
Cardiac Resynchronization ◽  
Cochrane Library ◽  
Complication Rates ◽  
Younger Patients ◽  
Risk Of Death

Background: The pivotal cardiac resynchronization therapy (CRT) trials enrolled patients significantly younger than the typical contemporary heart failure with reduced ejection fraction (HFrEF) patients. Benefits of CRT in older HFrEF patients is largely unknown and may be less due to higher comorbidity burdens and higher procedural risk. We sought to address this evidentiary gap through meta-analysis. Hypothesis: Compared to patients <70 years old (”younger”), patients ≥ 70 years old (“older”) have similar mortality rates, rates of complications and changes in ejection fraction (EF) following CRT. Methods: PubMed, The Cochrane Library, Scopus, and Web of Science were queried for comparative effectiveness studies of CRT in older HFrEF patients. Differences in mortality and mean difference (MD) in EF were calculated between groups. Random effects meta-analysis of MD in EF (older minus younger) and relative risk (RR) of death and complications are reported along with estimates of heterogeneity. Results: Seven studies [n= 4381 younger, 1203 older] were included in LVEF meta-analysis. Compared to younger patients, there was greater EF improvement in older patients [MD 1.20; 95% CI 0.13 - 2.28, p=0.03, I 2 =46%]. RR of mortality was analyzed for 11 studies [n=5038 younger, 1653 older] (Figure). Survival was better in younger patients [RR 1.06; 95% CI 1.04 - 1.09, p<0.01, I 2 =0%]. No significant differences in complication rates were observed between younger and older patients. Conclusions: CRT in older patients was associated with greater improvement in EF than younger patients. Mortality is greater in older patients which may reflect greater underlying risk of death from competing causes. Figures:

scholarly journals A meta-analysis of preoperative bronchoscopic marking for pulmonary nodules

2020 ◽  
Vol 58 (1) ◽  
pp. 40-50 ◽  
Author(s):  
Masahiro Yanagiya ◽  
Takuya Kawahara ◽  
Keiko Ueda ◽  
Daisuke Yoshida ◽  
Hirokazu Yamaguchi ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Pulmonary Nodules ◽  
Pulmonary Haemorrhage ◽  
Cochrane Library ◽  
Complication Rates ◽  
Resection Rate ◽  
Electromagnetic Navigation ◽  
Meta Analyses ◽  
Dye Marking ◽  
Pleural Injury

Abstract OBJECTIVES Recent studies have suggested the usefulness of preoperative bronchoscopic marking techniques for the localization of pulmonary nodules in thoracic surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative bronchoscopic marking. METHODS The PubMed and Cochrane Library databases were searched for clinical studies evaluating preoperative bronchoscopic marking for pulmonary resection. Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled success and complication rates of bronchoscopic marking. RESULTS Twenty-five eligible studies were included. Among these, 15 studies conducted dye marking under electromagnetic navigation bronchoscopy, 4 used virtual-assisted lung mapping and 7 used other marking methods. The overall pooled successful marking rate, successful resection rate and complete resection rate were 0.97 [95% confidence interval (CI) 0.95–0.99], 0.98 (95% CI 0.96–1.00) and 1.00 (95% CI 1.00–1.00), respectively. The overall pooled rates of pleural injury and pulmonary haemorrhage were 0.02 (95% CI 0.01–0.05) and 0.00 (95% CI 0.00–0.00), respectively. CONCLUSIONS This meta-analysis demonstrated that bronchoscopic marking is very safe and effective. Bronchoscopic marking should be considered, especially if there are concerns about the safety of other localization methods.

scholarly journals Safety and Efficacy of Bleb Needling with Antimetabolite after Trabeculectomy Failure in Glaucoma Patients: A Systemic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Xuhao Chen ◽  
Lingge Suo ◽  
Ying Hong ◽  
Chun Zhang
Keyword(s):  
Success Rate ◽  
Meta Analysis ◽  
Systemic Review ◽  
Cochrane Library ◽  
Subconjunctival Injection ◽  
Complication Rates ◽  
Safe Procedure ◽  
Success Rates ◽  
Whole Process ◽  
Before And After

Background. Bleb needling with subconjunctival injection of antimetabolites had become a widely accepted approach for trabeculectomy failure. However, IOP reduction effects, success rates, and complications occurrence for this procedure showed great inconsistency among the different studies. Methods. We conducted a literature search on PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. A random-effects model was performed on the extracted data based on the included studies. The intraocular pressure (IOP) and number of antiglaucomatous medications before and after the surgery were pooled for meta-analysis. The success and complication rates were estimated based on the results. Subgroup analysis, sensitivity analysis, and metaregression were applied to explore the origination of heterogeneity. Results. Thirty-seven studies with a total of 2182 patients were finally included in our review. For the present meta-analysis, the overall effects of bleb needling at the last visit revealed a reduction in IOP of 9.74 mmHg (95% confidence interval (CI) [8.85, 10.63]), 45.9% (95% CI [39.0%, 53.0%]) for complete success rate, and 70.4% (95% CI [63.5%, 77.0%]) for qualified success rate. Application of mitomycin C (MMC) and 5-fluorouracil (5-Fu) during the procedure were efficacious for IOP control during the follow-up. Metaregression revealed that possible origination of heterogeneity was baseline IOP before bleb needling, revealing a trend that higher baseline IOP correlated with a greater IOP reduction results p < 0.001 . For safety profile, conjunctival haemorrhage (5.7%, 95% CI [2.5%, 10.1%]), hyphema (5.5%, 95% CI [3.0%, 8.7%]), and bleb leakage (5.0%, 95% CI [3.2%, 7.3%]) had the highest estimate of incidence. An increasing number of needling was the main risk factor for needling failure. Conclusion. Bleb needling with antimetabolites could be considered an effective and safe procedure after trabeculectomy failure. After the process, patients will gain IOP control and reduce antiglaucomatous medications for at least six months with 5-Fu or MMC. Meanwhile, the overall estimates for complications were relatively low in the whole process.

scholarly journals The Effect of Intraoperative Methadone Compared to Morphine on Postsurgical Pain: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Mark C. Kendall ◽  
Lucas J. Alves ◽  
Kristi Pence ◽  
Taif Mukhdomi ◽  
Daniel Croxford ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Surgical Procedures ◽  
Meta Analysis ◽  
Analgesic Efficacy ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
Postanesthesia Care Unit ◽  
Controlled Trials ◽  
Randomized Controlled

Background and Objectives. Methadone is commonly used in chronic pain, but it is not frequently used as an intraoperative analgesic. Several randomized studies have compared intraoperative methadone to morphine regarding postsurgical analgesia, but they have generated conflicting results. The aim of this investigation was to compare the analgesic efficacy of intraoperative methadone to morphine in patients undergoing surgical procedures. Methods. We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases. Meta-analysis was performed using the random effects model, weighted mean differences (WMD), standard deviation, 95% confidence intervals, and sample size. Methodological quality was evaluated using Cochrane Collaboration’s tool. Results. Seven randomized controlled trials evaluating 337 patients across different surgical procedures were included. The aggregated effect of intraoperative methadone on postoperative opioid consumption did not reveal a significant effect, WMD (95% CI) of −0.51 (−1.79 to 0.76), (P=0.43) IV morphine equivalents. In contrast, the effect of methadone on postoperative pain demonstrated a significant effect in the postanesthesia care unit, WMD (95% CI) of −1.11 (−1.88 to −0.33), P=0.005, and at 24 hours, WMD (95% CI) of −1.35 (−2.03 to −0.67), P<0.001. Conclusions. The use of intraoperative methadone reduces postoperative pain when compared to morphine. In addition, the beneficial effect of methadone on postoperative pain is not attributable to an increase in postsurgical opioid consumption. Our results suggest that intraoperative methadone may be a viable strategy to reduce acute pain in surgical patients.

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