No abstract

Objectives/Hypothesis: To identify, describe, and where possible meaningfully synthesize the reported risk factors for postextubation dysphagia (PED) in critically ill patients.Study Design: Systematic review and meta-analysis. Methods: A systematic search of peer-reviewed and grey literature was conducted in common scientific databases to identify previously evaluated risk factors of PED. Data extraction and risk of bias assessment used a double-blind approach. Random effects models were used for the meta-analyses. Meta-analyses were conducted where sufficient study numbers allowed after accounting for statistical and clinical heterogeneity.Results: Twenty-five studies were included, which investigated a total of 150 potential risk factors. Of these, 63 risk factors were previously identified by at least one study each as significantly increasing the risk of PED. After accounting for clinical and statistical heterogeneity, only two risk factors were suitable for meta-analysis, gender, and duration of intubation. In separate meta-analyses, neither gender (RR 1.00 [0.71, 1.43], I 2 = 0%) nor duration of intubation 3.49], I 2 = 0%) were significant predictors of PED.Conclusions: A large number of risk factors for PED have been reported in the literature. However, significant variability in swallowing assessment methods, patient populations, timing of assessment, and duration of intubation prevented meaningful meta-analyses for the majority of these risk factors. Where meta-analysis was possible, gender and duration of intubation were not identified as risk factors for PED. We discuss future directions in clinical and research contexts.

Introduction Hypersensitivity is an unfortunate potential outcome in patients undergoing surgery following traumatic injuries to their hands. In our practice, we noted that certain suture types may increase the risk of the patient developing hypersensitivity. Methodology We conducted a retrospective observational study to investigate if certain suture materials increase the risk of hypersensitivity when used to repair surgical wounds in hand trauma. Patients undergoing hand trauma surgery over a period of five consecutive months were included in the study. Ethics committee approval was obtained from Peninsula Health’s research office. Results 184 patients were included in the study. Hypersensitivity was observed in 30 (16.3%) patients post-operatively. Chromic gut suture was used in 53.3% of the patients who experienced hypersensitivity. Patients who had chromic catgut used in their surgery were 2.82 times more likely to develop hypersensitivity than patients who did not have chromic gut used (p = 0.0015). If a patient had a nerve repaired and chromic gut sutured used, they were 6.50 times more likely to develop hypersensitivity (p < 0.0001). Conclusion Surgeons should be aware that this data indicates that suture choice in hand trauma patients can greatly impact the risk of the patient developing hypersensitivity. Level of evidence: Level IV, risk/prognostic study.