The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair: Comment on data sparsity

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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“…[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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“…Sir-Since our manuscript 1 was published, we have had the opportunity to review an editorial and 3 letters in response. [2][3][4][5] Such dialogue assures us that we have achieved our most important goal-generating a vibrant conversation to ensure we are all providing safe, effective, and quality care for our patients.…”

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confidence: 99%