The Efficacy and Safety of Intravenous Iron in Geriatric Hip Fracture Surgeries: A Systematic Review and Meta-Analysis
World journal of surgery. 2022
BACKGROUND With the increasing evidence provided by recent high-quality studies, the intravenous iron appears to be a reliable therapy for blood administration in geriatric patients with hip fractures. Here, this systematic review and meta-analysis were aimed to assess the effectiveness and safety of intravenous iron in geriatric patients sustaining hip fractures. METHODS Potential pertinent literatures evaluating the effects of intravenous iron in the geriatric patients undergoing hip fractures were identified from Web of Science, PubMed, Embase, and Scopus. We performed a pairwise meta-analysis using fixed- and random-effects models, and the pooling of data was carried out by using RevMan 5.1. RESULTS Four randomized controlled trials and four observational studies conform to inclusion criteria. The results of meta-analysis showed that intravenous iron reduced transfusion rates compared to the control group, yet the result did not reach statistical significance. The intravenous iron was related to lower transfusion volumes, shorter length of stay, and a reduced risk of nosocomial infections. And there was no significant difference in terms of the mortality and other complications between the treatment group and the control group. CONCLUSION Current evidence suggests that intravenous iron reduces the transfusion volume, length of hospital stay, and risk of nosocomial infections. It takes about 7 days for intravenous iron to elevate hemoglobin by 1 g/dl and about 1 month for 2 g/dl. The safety profile of intravenous iron is also reassuring, and additional high-quality studies are needed.
Intra-articular versus intravenous administration of tranexamic acid in lower limb total arthroplasty: a systematic review and meta-analysis of randomised clinical trials
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. 2022
AIM: The ideal route of tranexamic acid (TXA) administration in total hip arthroplasty (THA) or total knee arthroplasty (TKA) remains controversial. This study aims to identify the optima route of TXA administration in THA or TKA. METHODS PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched until 4 August 2021 for randomised studies that compared intravenous (IV) or intra-articular (IA) administration of TXA in THA or TKA. RESULTS Sixty-seven studies enrolling 8335 patients (IA: 4162; IV: 4173) were eligible for quantitative and qualitative analysis. Comparable results were demonstrated in the incidence of venous thromboembolisation (OR:0.96, p = 0.84), total blood loss (MD: - 9.05, p = 0.36), drain output (MD: - 7.36, p = 0.54), hidden blood loss (MD: - 6.85, p = 0.47), postoperative haemoglobin level (MD: 0.01, p = 0.91), haemoglobin drop (MD: - 0.10, p = 0.22), blood transfusion rate (OR: 0.99, p = 0.87), total adverse events (OR: 1.12, p = 0.28), postoperative range of motion (MD: 1.08, p = 0.36), postoperative VAS pain score (MD: 0.13, p = 0.24) and postoperative D-dimer level (MD: 0.61, p = 0.64). IV route of TXA administration was associated with significantly longer length of hospital stay compared to IA route of administration (MD: - 0.22, p = 0.01). CONCLUSION In this meta-analysis, both IV and IA route of TXA administration were equally effective in managing blood loss and postoperative outcomes in lower limb joints arthroplasty. LEVEL OF EVIDENCE Level 1. PROSPERO Registration CRD42021271355.
The Use of Tranexamic Acid for Elective Resection of Intracranial Neoplasms: A Systematic Review
World neurosurgery. 2022
BACKGROUND As an established antifibrinolytic agent, tranexamic acid (TXA) has garnered widespread use during surgery to limit intraoperative blood loss. Within the field of neurosurgery, it is often introduced in cases of traumatic brain injury or elective spine surgeries. However, its role during elective cranial surgeries is not well established. This study presents a systematic review of the use of TXA for elective surgical resection of intracranial neoplasms. METHODS We performed a systematic review using PRISMA guidelines to identify studies investigating the TXA use in elective neurosurgical resection of intracranial neoplasms. Variables extracted included patient demographics, surgical indications, type of surgery performed, TXA administration dose and route, operative duration, blood loss, transfusion rate, postoperative hemoglobin (Hb) levels, and complications. RESULTS After careful screening, 4 articles (consisting of 682 total patients) fit our inclusion/exclusion criteria. Two studies were prospective cohorts, one was a retrospective cohort, and one was a case series. Chi-squared testing of pooled data demonstrated that patients administered TXA had a significantly decreased need for blood transfusions during surgery (OR: 0.6273, 95% CI:0.4254-0.9251, p=0.018). Mean total blood loss was 821.9 mL in the TXA group and 1099.0 mL in the control group across studies. There was no significant difference in postoperative hemoglobin levels: means were 11.4 g/dL for both the TXA and control groups. CONCLUSION These results support the use of intraoperative TXA in tumor resection. However, its role in tumor resection has been less investigated when compared to the use of TXA in other areas of neurosurgery.
Sinus Lift Associated with Leucocyte-Platelet-Rich Fibrin (Second Generation) for Bone Gain: A Systematic Review
Journal of clinical medicine. 2022;11(7)
The purpose of this systematic review was to analyze sinus lifting procedures and to compare the efficiency of this treatment associated with the second generation of platelet-rich fibrin related to its effects on bone gain and to clarify the regenerative efficacy in sinus lift procedure, whether alone or as a coadjutant to other bone graft materials. The PICOT question was, "In clinical studies with patients needing a maxillary sinus lift (P), does the use of PRF either alone (I) or in conjunction with other biomaterials (C) improve the clinical outcome associated with bone gain and density (O), with at least three months of follow-up (T)?" An electronic search was conducted in the MEDLINE (PubMed), Science Direct, and Scopus databases through a search strategy. A total of 443 articles were obtained from the electronic database search. Sixteen articles met all criteria and were included in this review. Within the limitation of this study and interpreting the results carefully, it was suggested that a higher risk for implant failure after a sinus elevation might be seen in patients with residual bone ≤4 mm, and PRF application was effective, suggesting reducing the time needed for new bone formation.
A systematic review and meta-analysis of safety and efficacy of over the scope clips versus standard therapy for high-risk non-variceal upper gastrointestinal bleeding
Gastrointestinal endoscopy. 2022
BACKGROUND AND AIMS Upper gastro-intestinal bleeding is a common condition associated with significant morbidity and mortality. Endoscopic hemostasis remains the mainstay of therapy and is mainly aimed at effective hemostasis and prevention of rebleeding. Lesions with high-risk stigmata can have rebleeding rates of as high as 26.3%. Rebleeding is associated with increased mortality and reduced success rates of endoscopic retreatment. The over-the-scope-clip (OTSC) is a device with widespread endoscopic indications including hemostasis for non-variceal upper GIB (NVUGIB). The current study presents a systematic review and meta-analysis comparing OTSC versus standard therapy (STD) for NVUGIB. METHODS Multiple databases were searched through April 2022 for studies comparing OTSC and standard therapy for NVUGIBs. The primary outcomes were clinical success rates, rebleeding rates, procedure times and secondary outcomes were mortality rates and length of hospitalization. Meta-analysis was performed to determine pooled odds ratios (ORs) to compare outcomes between the OTSC and standard therapy groups. RESULTS Ten studies, including four randomized controlled trials, with 914 patients were included in the final analysis. 431 patients with NVUGIB's were treated with OTSC and 483 patients were treated with STD. Patients treated with OTSC had an overall lower risk of 7-day (RR 0.41 (95% CI 0.24-0.68, I(2) = 0%)) and 30-day rebleeding (RR 0.46 (95% CI 0.31-0.65, I(2) = 0%)). Clinical success rates were higher with OTSC compared with STD (RR 1.36 (95% CI 1.06 - 1.75. Mean procedure time was shorter in the OTSC group by 6.62 min (95% CI 2.58 - 10.67) vs STD therapy. I(2) = 84%. There was no statistically significant difference in terms of mortality between the OTSC and STD groups, RR 0.55 (95% CI 0.24-1.24, I(2) = 0%). Length of hospitalization was comparable between both groups with the pooled mean difference for OTSC vs STD being 0.87 d (-1.62 d - 3.36 d, I(2) = 71%). CONCLUSIONS While our study is limited to high-risk NVUGIB's, our analysis shows that hemostasis with OTSC is associated with a lower 7-day and 30-day rebleeding rate, higher clinical success rates and shorter procedure time with similar mortality rates and length of hospital stay as compared to standard therapy.
Tranexamic acid vs placebo and its impact on bleeding, transfusions and stone-free rates in percutaneous nephrolithotomy: a systematic review and meta-analysis
Central European journal of urology. 2022;75(1):81-89
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is the standard of care for the treatment of large renal stones. Bleeding-related complications remain a major concern when performing this procedure. Tranexamic acid (TXA) has recently been studied in both urologic and non-urologic procedures to reduce bleeding, transfusions and complications. MATERIAL AND METHODS In June 2021 a systematic review was conducted following PRISMA guidelines on randomized prospective studies comparing the effects of TXA on bleeding complications during PCNL. Data was analyzed using Review Manager 5.3. RESULTS Eight studies were included with a total 1,201 patients, of which 598 received TXA and 603 received placebo. TXA was associated with less bleeding (decreased change in hemoglobin) -0.79 Hb g/dl [-1.09, -0.65] p <.00001 and decreased transfusion rates (OR 0.31 [0.18, 0.52] p <0.0001). This was also associated with lower complication rates, both minor, major and overall, OR 0.59[0.41, .85] p = 0.005, OR 0.31 [0.17, 0.56] p = 0.0001 and OR 0.40 [0.29, 0.56] p <0.00001 respectively. TXA was also associated with improved stone-free rates as compared with placebo (OR 1.79 [1.23, 2.62] p = 0.003). TXA resulted in shorter operative times (11.51 minutes [-16.25, -6.77] p =.001) and length of stay (-0.74 days [-1.13 -0.34] p = 0.0006). Two pulmonary embolisms were registered in a single study in the TXA group. CONCLUSIONS In this meta-analysis, the use of TXA during PCNL was associated with a statistically significant reduction in the following parameters when compared with placebo: change in hemoglobin, transfusion rates, complication rates, operative time, and length of stay. It was also associated with improvement in stone-free rates. These data should be considered by surgeons performing PCNL.
Pre-operative iron increases haemoglobin concentration before abdominal surgery: a systematic review and meta-analysis of randomized controlled trials
Scientific reports. 2022;12(1):2158
Professional surgical societies recommend the identification and treatment of pre-operative anaemia in patients scheduled for abdominal surgery. Our aim was to determine if pre-operative iron allows correction of haemoglobin concentration and decreased incidence of peri-operative blood transfusion in patients undergoing major abdominal surgery. MEDLINE, Embase and CENTRAL were searched for RCTs written in English and assessing the effect of pre-operative iron on the incidence of peri-operative allogeneic blood transfusion in patients undergoing major abdominal surgery. Pooled relative risk (RR), risk difference (RD) and mean difference (MD) were obtained using models with random effects. Heterogeneity was assessed using the Q-test and quantified using the I(2) value. Four RCTs were retained for analysis out of 285 eligible articles. MD in haemoglobin concentration between patients with pre-operative iron and patients without pre-operative iron was of 0.81 g/dl (3 RCTs, 95% CI 0.30 to 1.33, I(2): 60%, p = 0.002). Pre-operative iron did not lead to reduction in the incidence of peri-operative blood transfusion in terms of RD (4 RCTs, RD: - 0.13, 95% CI - 0.27 to 0.01, I(2): 65%, p = 0.07) or RR (4 RCTs, RR: 0.57, 95% CI 0.30 to 1.09, I(2): 64%, p = 0.09). To conclude, pre-operative iron significantly increases haemoglobin concentration by 0.81 g/dl before abdominal surgery but does not reduce the need for peri-operative blood transfusion. Important heterogeneity exists between existing RCTs in terms of populations and interventions. Future trials should target patients suffering from iron-deficiency anaemia and assess the effect of intervention on anaemia-related complications.
Patients undergoing major abdominal surgery (4 studies, n= 651).
Placebo or usual care.
Mean difference in haemoglobin concentration between patients with pre-operative iron and patients without pre-operative iron was of 0.81 g/dl. Pre-operative iron did not lead to reduction in the incidence of peri-operative blood transfusion in terms of risk difference (RD) or pooled relative risk (RR), (RD: - 0.13, RR: 0.57).
Influence of platelet-rich plasma (PRP) analogues on healing and clinical outcomes following anterior cruciate ligament (ACL) reconstructive surgery: a systematic review
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. 2022
PURPOSE To systematically review the effect of PRP on healing (vascularization, inflammation and ligamentization) and clinical outcomes (pain, knee function and stability) in patients undergoing ACL reconstruction and compare the preparation and application of PRP. METHODS Independent systematic searches of online databases (Medline, Embase and Web of Science) were conducted following PRISMA guidelines (final search 10th July 2021). Studies were screened against inclusion criteria and risk of bias assessed using Critical appraisal skills programme (CASP) Randomised controlled trial (RCT) checklist. Independent data extraction preceded narrative analysis. RESULTS 13 RCTs were included. The methods of PRP collection and application were varied. Significant early increases in rate of ligamentization and vascularisation were observed alongside early decreases in inflammation. No significant results were achieved in the later stages of the healing process. Significantly improved pain and knee function was found but no consensus reached. CONCLUSIONS PRP influences healing through early vascularisation, culminating in higher rates of ligamentization. Long-term effects were not demonstrated suggesting the influence of PRP is limited. No consensus was reached on the impact of PRP on pain, knee stability and resultant knee function, providing avenues for further research. Subsequent investigations could incorporate multiple doses over time, more frequent observation and comparisons of different forms of PRP. The lack of standardisation of PRP collection and application techniques makes comparison difficult. Due to considerable heterogeneity, (I(2) > 50%), a formal meta-analysis was not possible highlighting the need for further high quality RCTs to assess the effectiveness of PRP. The biasing towards young males highlights the need for a more diverse range of participants to make the study more applicable to the general population. TRAIL REGISTRATION CRD42021242078CRD, 15th March 2021, retrospectively registered.
Does Intraoperative Blood Loss Affect the Short-Term Outcomes and Prognosis of Gastric Cancer Patients After Gastrectomy? A Meta-Analysis
Frontiers in surgery. 2022;9:924444
PURPOSE The purpose of the current meta-analysis was to analyze whether intraoperative blood loss (IBL) influenced the complications and prognosis of gastric cancer patients after gastrectomy. METHODS We systematically searched the PubMed, Embase and Cochrane library databases on November 29, 2021. The Newcastle-Ottawa scale was used to evaluate the quality of included studies. This meta-analysis uses RevMan 5.3 for data analysis. RESULTS A total of nine retrospective studies were included in this meta-analysis, involving 4653 patients. In terms of short-term outcomes, the Larger IBL group has a higher complication rate (OR = 1.94, 95% CI, 1.44 to 2.61, P < 0.0001) and a longer operation time (OR = 77.60, 95% CI, 41.95 to 113.25, P < 0.0001) compared with the smaller IBL group, but the Larger IBL group had higher total retrieved lymph nodes (OR = 3.68, 95% CI, 1.13 to 6.24, P = 0.005). After pooling up all the HRs, the Larger IBL group has worse overall survival (OS) (HR = 1.80, 95% CI, 1.27 to 2.56, P = 0.001) and disease-free survival (DFS) (HR = 1.48, 95% CI, 1.28 to 1.72, P < 0.00001). CONCLUSION Larger IBL increased operation time and postoperative complications, and decreased OS and DFS of gastric cancer patients. Therefore, surgeons should be cautious about IBL during operation.
Is TXA beneficial in open spine surgery? And its effects vary by dosage, age, sites, and locations: A meta-analysis of randomized controlled trials
World neurosurgery. 2022
BACKGROUND The role of tranexamic acid (TXA) in controlling blood loss during spine surgery remains unclear. With the publication of a new randomized-controlled trial (RCT), we conducted a meta-analysis to determine the safety and Efficacy of TXA in spine surgery. METHODS PubMed, Embase, Web of Science, and Cochrane databases were searched for relevant studies through 2022. Only randomized controlled trials were eligible for this study. The extracted data were analyzed using Revman 5.3 software for meta-analysis. RESULTS Twenty randomized controlled trials including 1497 patients undergoing spine surgery were included in this systematic evaluation. Compared with the control group, TXA significantly reduced total blood loss [mean difference (MD) - 218.96, 95% confidence interval（CI） - 309.77 to - 128.14, p < 0.00001], perioperative blood loss [MD - 90.54, 95%（CI） - 139.33 to - 41.75, p =0.0003], postoperative drainage [MD - 102.60, 95%（CI） - 139.51 to - 65.70, p < 0.00001]，reduced hospital stay [MD - 1.42, 95%（CI） - 2.71 to - 0.14, p=0.03], reduced total blood transfusion volume [MD - 551.06, 95%（CI） - 755.90 to - 346.22, p < 0.00001] and INR [MD -0.03, 95%（CI） -0.04 to-0.02, p < 0.00001]. CONCLUSION Based on the meta-analysis of 20 RCTs, we demonstrated that TXA reduces blood loss in open spine surgery, decreases transfusion rates, and shortens hospital stays. The TXA administration during the perioperative period does not increase the incidence of postoperative complications.