Judging causal associations in observational research on caudal anesthesia and hypospadias repair

Haydar, Bishr

doi:10.1111/pan.13260

Cited by 3 publications

(2 citation statements)

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“…[27] Hayder has pointed out the possibility of a lack of internal validity due to unequal administration of caudal anesthesia (selection bias) and referred to Hill's criteria for judging causal association in observational research. [2829] The OR shrunk and the CI narrowed when the penalization via data augmentation was used to analyze the proposed association. [30]…”

Section: Discussionmentioning

confidence: 99%

Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis

et al. 2019

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Introduction: Caudal block analgesia is administered to lower the requirements of systemic and inhaled anesthetic drugs during hypospadias surgery. However, recent reports, all clustered in a short time-span have generated controversial and mutually opposing results while evaluating caudal block as an independent risk factor for urethroplasty-related complications after hypospadias repair. There is no consensus statement on the role of caudal block analgesia in formation of urethrocutaneous fistula (UCF) after hypospadias surgery. We performed a systematic review and meta-analysis of the studies evaluating the relative rates of UCF formation after hypospadias surgery in patients who were administered caudal block analgesia versus in those who were not. Methods: Electronic searches were performed using PubMed, PubMed Central, Google Scholar, Ovid, and the Cochrane library. Statistical analysis was performed using a fixed-effect model, odds ratios, risk ratios (RR), and heterogeneity (I 2 ) were calculated. Funnel plot was used to assess for publication bias. Results: Seven studies with 1706 patients were included. Caudal block analgesia is associated with a significantly higher risk of UCF formation (RR: 1.81; 95% confidence interval [CI]: 1.30–2.53), ( P = 0.0004) and other urethroplasty-related complications (RR 2.01; 95% CI: 1.48–2.74), ( P < 0.00001) after hypospadias surgery. Funnel plots indicate some publication bias. Conclusions: In patients undergoing hypospadias repair, administration of caudal analgesia is associated with a higher risk of UCF formation and other urethroplasty-related complications.

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Section: Discussionmentioning

confidence: 99%

Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis

et al. 2019

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“…This is, simply put, untrue. During the preparation of our manuscript on caudal analgesia in hypospadias patients, included in their review, we extensively searched the literature to find evidence of epidural anesthesia or analgesia causing edema in humans and found none 2 3. Dr Kundra postulated that penile engorgement due to the sympathectomy caused by caudal anesthesia led to edema,4 but this is a normal physiological process that is not associated with edema formation.…”

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confidence: 99%

Hypospadias repair and caudal analgesia: biases and myths hinder meaningful meta-analysis

Haydar

Freed

2019

Reg Anesth Pain Med

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Reply to comments on ‘The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair’

Taicher¹,

Routh

Eck³

et al. 2018

Pediatric Anesthesia

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Judging causal associations in observational research on caudal anesthesia and hypospadias repair

Cited by 3 publications

References 8 publications

Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis

Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis

Hypospadias repair and caudal analgesia: biases and myths hinder meaningful meta-analysis

Reply to comments on ‘The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair’

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