1.
The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis
Farhan-Alanie MM, Dhaif F, Trompeter A, Underwood M, Yeung J, Parsons N, Metcalfe A, Wall PDH
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. 2021
Abstract
PURPOSE Tourniquet use in lower limb fracture surgery may reduce intra-operative bleeding, improve surgical field of view and reduce length of procedure. However, tourniquets may result in pain and the production of harmful metabolites cause complications or affect functional outcomes. This systematic review aimed to compare outcomes following lower limb fracture surgery performed with or without tourniquet. METHODS We searched databases for RCTs comparing lower limb fracture surgery performed with versus without tourniquet reporting on outcomes pain, physical function, health-related quality of life, complications, cognitive function, blood loss, length of stay, length of procedure, swelling, time to union, surgical field of view, volume of anaesthetic agent, biochemical markers of inflammation and injury, and electrolyte and acid-base balance. Random-effects meta-analysis was performed. PROSPERO ID CRD42020209310. RESULTS Six RCTs enabled inclusion of 552 procedures. Pooled analysis demonstrated that tourniquet use reduced length of procedure by 6 minutes (95% CI -10.12 to -1.87; p < 0.010). We were unable to exclude increased harms from tourniquet use. Pooled analysis showed post-operative pain score was higher in tourniquet group by 12.88 on 100-point scale (95% CI -1.25-27.02; p = 0.070). Risk differences for wound infection, deep venous thrombosis and re-operation were 0.06 (95% CI -0.00-0.12; p = 0.070), 0.05 (95% CI -0.02-0.11; p = 0.150) and 0.03 (95% CI -0.03-0.09; p = 0.340). CONCLUSION Tourniquet use was associated with a reduced length of procedure. It is possible that tourniquets also increase incidence of important complications, but the data are too sparse to draw firm conclusions. Methodological weaknesses of the included RCTs prevent any solid conclusions being drawn for outcomes investigated. Further studies are required to address these limitations.
2.
Biologic Treatment Outcomes in Mucous Membrane Pemphigoid: A Systematic Review
Lytvyn Y, Rahat S, Mufti A, Witol A, Bagit A, Sachdeva M, Yeung J
Journal of the American Academy of Dermatology. 2021
Abstract
BACKGROUND Mucous membrane pemphigoid (MMP) is an autoimmune disease, which can lead to fibrosis of mucous membranes and functional impairment. Biologic agents should be explored as alternative treatment options to improve outcomes. OBJECTIVE To conduct a systematic review of biologic treatment outcomes in patients with MMP. METHODS MEDLINE and EMBASE search was conducted on July 23(rd), 2020 to include 63 studies using PRISMA guidelines. RESULTS Use of IVIG (n=154), rituximab (n=112), TNFα inhibitors (n=7), and combination treatments (n=58) were reported in 331 patients with MMP. IVIG led to complete resolution in 61.7% (n=95/154) of patients within 26.0 months, with a recurrence rate of 22.7% (n=35/154) and headache as the most common side effect (8.4%, n=13/154). Rituximab led to complete resolution in 70.5% (n=79/112) of patients within 8.7 months, with a recurrence rate of 35.7% (n=40/112). Most commonly reported side effects were urinary tract infections (4.5%, n=5/112), leukocytopenia (2.7%, n=3/112), death due to severe infections (1.8%, n=2/112). TNFα inhibitors led to complete resolution in 71.4% (n=5/7) of patients within 3.9 months of treatment, without reported adverse events. CONCLUSIONS Randomized clinical trials with long term follow up are required to conclude the promising safety and efficacy of biologic agents in MMP patients.
3.
The effect of intravenous iron on erythropoiesis in older people with hip fracture
Moppett IK, Rowlands M, Mannings AM, Marufu TC, Sahota O, Yeung J
Age and ageing. 2019
Abstract
BACKGROUND anaemia following hip fracture is common and associated with worse outcomes. Intravenous iron is a potential non-transfusion treatment for this anaemia and has been found to reduce transfusion rates in previous observational studies. There is good evidence for its use in elective surgical populations. OBJECTIVE to examine the impact of intravenous iron on erythropoiesis following hip fracture. DESIGN two-centre, assessor-blinded, randomised, controlled trial of patients with primary hip fracture and no contra-indications to intravenous iron. METHOD the intervention group received three doses of 200 mg iron sucrose over 30 min (Venofer, Vifor Pharma, Bagshot Park, UK) on three separate days. Primary outcome was reticulocyte count at day 7 after randomisation. Secondary outcomes included haemoglobin concentration, complications and discharge destination. Eighty participants were randomised. RESULTS there was a statistically significantly greater absolute final reticulocyte count in the iron group (89.4 (78.9-101.3) x 109 cells l-1 (n = 39) vs. the control (72.2 (63.9-86.4)) x 109 cells l-1 (n = 41); P = 0.019; (mean (95% confidence intervals) of log-transformed data). There were no differences in final haemoglobin concentration (99.9 (95.7-104.2) vs. 102.0 (98.7-105.3) P = 0.454) or transfusion requirements in the first week (11 (28%) vs. 12 (29%); P = 0.899). Functional and safety outcomes were not different between the groups. CONCLUSIONS although intravenous iron does stimulate erythropoiesis following hip fracture in older people, the effect is too small and too late to affect transfusion rates. Trial Registry Numbers: ISRCTN76424792; EuDRACT 2011-003233-34.