Meta-analysis in Surgery

Ng, Tina T.; McGory, Marcia L.; Ko, Clifford Y.; Maggard, Melinda A.

doi:10.1001/archsurg.141.11.1125

Cited by 56 publications

(12 citation statements)

References 27 publications

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“…However, in practice, RCT is very rare, especially for surgery [38,39]. In this systematic review, all the studies selected were not RCT, while it did not influence the credibility of the results.…”

Section: Discussionmentioning

confidence: 99%

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review

Liu

Cheng

et al. 2010

Eur Spine J

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The objective of the study is to perform a systematic review to compare the clinical outcomes and complications of anterior surgery with posterior surgery for multilevel cervical myelopathy (MCM). MEDLINE, EM-BASE databases and other databases were searched for all the relevant original articles published from January 1991 to November 2009 comparing anterior with posterior surgery for MCM. Subgroup analysis was performed according to the follow-up years. The following end points were mainly evaluated: final follow-up JOA (Japanese Orthopaedic Association) scale, recovery rate and complication outcomes. Ten articles fulfilled all inclusion criteria. For multilevel CSM patients, the final follow-up JOA score for the anterior group was significantly higher than the posterior group (p \ 0.05, WMD 0.83 [0.24, 1.43] [31] which mean follow-up time was 6 years was enrolled in the 'follow-up time [5 years' subgroup. The results showed there was no significant difference in final follow-up JOA score and recovery rate between anterior and posterior group for patients with occupying ratio of OPLL \60% (p [ 0.05), while in patients with occupying ratio C60%, the final follow-up JOA score and recovery rate of anterior surgery were both superior to that of posterior surgery (p \ 0.05). For both multilevel CSM and OPLL patients, the complications for the anterior group were significantly more than the posterior group in the 'follow-up time B5 years' subgroup (p \ 0. 05, OR 7.33 [2.96, 18.20 (2011( ) 20:224-235 DOI 10.1007( /s00586-010-1486 OPLL patients with occupying ratio C60%, anterior surgery had superior clinical outcome to posterior surgery.Eur Spine J

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Section: Discussionmentioning

confidence: 99%

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review

Liu

Cheng

et al. 2010

Eur Spine J

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“…Furthermore, large heterogeneity was detected for the outcome hospital stay. The degree of between trial heterogeneity present may affect the quality and legitimacy of the results obtained [38]. Lastly, none of the included RCTs was double blinded.…”

Section: Discussionmentioning

confidence: 99%

Fast-Track Programs Versus Traditional Care in Hepatectomy: A Meta-Analysis of Randomized Controlled Trials

Lei

Wang²,

Tan³

et al. 2014

Dig Surg

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Background/Aims: The role of fast-track programs in hepatectomy is unclear. This meta-analysis aimed to evaluate the efficacy and safety of fast-track programs versus traditional care. Methods: We searched Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar for relevant randomized controlled trials (RCTs) comparing fast-track with traditional care in hepatectomy. Length of hospital stay, time to first flatus, postoperative complications, operating time, and intraoperative blood loss were assessed. Meta-analyses were performed using RevMan 5.2 software. Results: Four original RCTs with 372 patients were included: 187 in the fast-track and 185 in the traditional care group. Fast-track patients had shorter hospital stay (WMD -2.32; 95% CI, -3.54 to -1.11; p < 0.001) and time to first flatus (WMD -0.99; 95% CI, -1.15 to -0.84; p < 0.001), and less postoperative complications (RR 0.66; 95% CI, 0.47 to 0.93; p < 0.05). However, there was significant heterogeneity between the studies regarding hospital stay (I² = 88%; p < 0.001). Operating time and intraoperative blood loss were not different. Conclusions: Patients in fast-track programs had less time to first flatus and postoperative complications compared to traditional care. Fast-track programs may reduce the length of hospital stay. Larger, higher quality prospective RCTs are necessary to draw more robust conclusions.

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“…However, in practice, RCT is very rare, especially for surgery. 33 , 34 It is because treatment with surgery is different from that with drugs. Every surgeon has his personal preference and familiarity with the various surgical options.…”

Section: Discussionmentioning

confidence: 99%

Kyphoplasty versus vertebroplasty for painful osteoporotic vertebral compression fractures—which one is better? A systematic review and meta-analysis

Yang¹,

Liu²,

Zhou³

et al. 2013

The International Journal of Spine Surgery

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BackgroundWhether kyphoplasty or vertebroplasty is better for painful osteoporotic vertebral compression fracture is a widely debated issue. Studies on the comparison of the 2 approaches are relative limited and a wide variation exists in the patient population, study design, and results. These factors make it difficult for workers in this field to know the exact value of the 2 approaches.ObjectiveTo perform a systematic review and meta-analysis to compare the clinical outcomes and complications of kyphoplasty versus vertebroplasty for painful osteoporotic vertebral compression fractures (OVCF).Study designA systematic review and meta-analysis.MethodsMEDLINE, EMBASE, and other databases were searched for all the relevant original articles published from January 1987 to September 2012 comparing kyphoplasty with vertebroplasty for painful OVCF. The following outcomes were mainly evaluated: visual analog scale (VAS), vertebral height, kyphosis angle, new vertebral fractures, and cement leakage.ResultsA total of 15 articles fulfilled all the inclusion criteria. The baseline characteristics such as sex, age, and number of prevalent fractures were comparable for both groups (P > .05). VAS score for the kyphoplasty group was significantly more than that for the vertebroplasty group at 1-3 days, 3 months, 6 months, 1 year, and 2 years after surgery (P < .05). Vertebral height in the kyphoplasty group was significantly higher than the vertebroplasty group at 3 months, 6 months, and 2 years (P < 0.05). Kyphosis angle in the kyphoplasty group was significantly lower at 3 months, 6 months, and 2 years (P < 0.05). The occurrence of new vertebral fractures in the kyphoplasty group had no significant difference with the vertebroplasty group at 3 months, 6 months, and 2 years (P > 0.05). The occurrence of cement leakage was significantly lower in the vertebroplasty group (P < 0.05).LimitationsThe main limitations of this review are that the demographics and comorbidities of study participants were not reported. These possible sources of heterogeneity could not be examined.ConclusionsPercutaneous kyphoplasty is better than vertebroplasty in the treatment of painful OVCF. Kyphoplasty had better improvement at VAS score, vertebral height, and kyphosis angle with lower occurrence of cement leakage.

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Meta-analysis in Surgery

Cited by 56 publications

References 27 publications

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review

Fast-Track Programs Versus Traditional Care in Hepatectomy: A Meta-Analysis of Randomized Controlled Trials

Kyphoplasty versus vertebroplasty for painful osteoporotic vertebral compression fractures—which one is better? A systematic review and meta-analysis

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