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Kumar SS, Collings AT, Wunker C, Athanasiadis DI, DeLong CG, Hong JS, Ansari MT, Abou-Setta A, Oliver E, Berghella V, Alli V, Hassan I, Hollands C, Sylla P, Slater BJ, Palazzo F. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 2024; 38:2947-2963. [PMID: 38700549 PMCID: PMC11133165 DOI: 10.1007/s00464-024-10810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/21/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND When pregnant patients present with nonobstetric pathology, the physicians caring for them may be uncertain about the optimal management strategy. The aim of this guideline is to develop evidence-based recommendations for pregnant patients presenting with common surgical pathologies including appendicitis, biliary disease, and inflammatory bowel disease (IBD). METHODS The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee convened a working group to address these issues. The group generated five key questions and completed a systematic review and meta-analysis of the literature. An expert panel then met to form evidence-based recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Expert opinion was utilized when the available evidence was deemed insufficient. RESULTS The expert panel agreed on ten recommendations addressing the management of appendicitis, biliary disease, and IBD during pregnancy. CONCLUSIONS Conditional recommendations were made in favor of appendectomy over nonoperative treatment of appendicitis, laparoscopic appendectomy over open appendectomy, and laparoscopic cholecystectomy over nonoperative treatment of biliary disease and acute cholecystitis specifically. Based on expert opinion, the panel also suggested either operative or nonoperative treatment of biliary diseases other than acute cholecystitis in the third trimester, endoscopic retrograde cholangiopancreatography rather than common bile duct exploration for symptomatic choledocholithiasis, applying the same criteria for emergent surgical intervention in pregnant and non-pregnant IBD patients, utilizing an open rather than minimally invasive approach for pregnant patients requiring emergent surgical treatment of IBD, and managing pregnant patients with active IBD flares in a multidisciplinary fashion at centers with IBD expertise.
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Affiliation(s)
- Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Amelia T Collings
- Hiram C. Polk, Jr Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Claire Wunker
- Department of Surgery, Saint Louis University, Saint Louis, MO, USA
| | | | - Colin G DeLong
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Julie S Hong
- Department of Surgery, NewYork-Presbyterian Queens, New York, NY, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ahmed Abou-Setta
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Emily Oliver
- Department of Obstetrics, Gynecology and Reproductive Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Vincenzo Berghella
- Department of Obstetrics & Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vamsi Alli
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Imran Hassan
- Department of Surgery, Mercy Medical Center Cedar Rapids, Cedar Rapids, IA, USA
| | - Celeste Hollands
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Mount Sinai Health System, New York, NY, USA
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- Thomas Jefferson University, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA.
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2
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Pantelis AG, Machairiotis N, Stavros S, Potiris A, Karampitsakos T, Lapatsanis DP, Drakakis P. Laparoscopic Surgery During Pregnancy: A Meta-Review and Quality Analysis Using the Assessment of Multiple Systematic Reviews (AMSTAR) 2 Instrument. Cureus 2024; 16:e63521. [PMID: 39081423 PMCID: PMC11288481 DOI: 10.7759/cureus.63521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
Accumulation of experience with minimally invasive surgery over the last three decades has rendered laparoscopic surgery the mainstay of management for surgical pathology during pregnancy. In the present meta-review, we compiled the available evidence on the safety of laparoscopic and robotic-assisted surgeries during pregnancy, based on relevant systematic reviews (SR) and meta-analyses (MA). A systematic review was performed for articles published until February 2024 in English using PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) and Google Scholar based on predefined selection and exclusion criteria. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included SRs and MAs examining women of childbearing age (population) who had undergone laparoscopic surgery or robotic-assisted laparoscopic surgery during pregnancy (intervention). The presence of comparison to open surgery was desirable but not mandatory (comparator). The included studies should necessarily report on fetal loss (outcome), and optionally on other metrics of fetal, maternal, or operative performance. We considered SRs/MAs analyzing randomized trials, observational studies, case reports, and case series (study design). The methodological quality of SRs/MAs not exclusively including case reports and case series was assessed with the Assessment of Multiple Systematic Reviews (AMSTAR) 2 instrument. A total of 1229 articles were screened, of which 78 were potentially eligible. Of these, 33 articles met our inclusion criteria, 18 containing SRs only and 15 SRs with MA. The examined disciplines were laparoscopic appendectomy (10 studies, 30.3%), laparoscopic cerclage for cervical insufficiency (eight studies, 24.2%), adnexal-ovarian laparoscopic surgery (five studies, 15.2%), laparoscopic cholecystectomy and biliary tree exploration (three studies, 9.1%), laparoscopic myomectomy (two studies, 6.1%), and one study each for laparoscopic surgery regarding pancreatic indications, adrenal indications, and bariatric complications (3.0%). The odds ratio/relative risk for fetal loss rate ranged from 0-1.9, with variable statistical significance depending on the discipline. Twenty-three out of the 33 studies were submitted to quality evaluation with the AMSTAR 2 instrument, with three being of "low quality" (13.0%) and the remaining 20 of "critically low quality" (87.0%). In conclusion, the widespread acceptance of laparoscopic surgery for treating surgical pathology during pregnancy is substantiated by heterogeneous and low-quality evidence. Literature mainly revolves around laparoscopic appendectomy, whereas other disciplines that may commonly arise during pregnancy, such as cholecystectomy and the acute abdomen following bariatric surgery, are underrepresented in the literature. Factors such as anatomical alterations that may affect surgical access, surgeon's expertise, and the biological course of the underlying pathology should be taken into consideration when selecting the appropriate mode of operating during pregnancy.
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Affiliation(s)
- Athanasios G Pantelis
- Surgical Department of Obesity and Metabolic Disorders, Athens Medical Group, Psychiko Clinic, Athens, GRC
| | - Nikolaos Machairiotis
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Anastasios Potiris
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Theodoros Karampitsakos
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Dimitris P Lapatsanis
- Surgical Department of Obesity and Metabolic Disorders, Athens Medical Group, Psychiko Clinic, Athens, GRC
| | - Petros Drakakis
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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3
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Lipping E, Saar S, Rull K, Tark A, Tiiman M, Jaanimäe L, Lepner U, Talving P. Open versus laparoscopic appendectomy for acute appendicitis in pregnancy: a population-based study. Surg Endosc 2023:10.1007/s00464-023-10075-0. [PMID: 37099158 DOI: 10.1007/s00464-023-10075-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/25/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Laparoscopic appendectomy (LA) is the standard treatment for acute appendicitis (AA) in general population. However, the safety of LA during pregnancy has remained a matter of debate. The purpose of this study was to compare surgical and obstetrical outcomes in pregnant women who underwent LA vs. open appendectomy (OA) for AA. We hypothesized that LA results in improved surgical and obstetric outcomes during pregnancy. METHODS Using a nationwide claim-based database in Estonia, a retrospective review of all cases of pregnant women undergoing OA or LA for AA from 2010 to 2020 was performed. Patient characteristics, surgical and obstetrical outcomes were analyzed. Primary outcomes were preterm delivery, fetal loss and perinatal mortality. Secondary outcomes included operative time, hospital length of stay (HLOS) and 30-day postoperative complications. RESULTS Overall, 102 patients were included of whom 68 (67%) underwent OA and 34 patients (33%) LA, respectively. Patients in LA cohort had a significantly shorter length of pregnancy in terms of gestational weeks when compared to OA cohort (12 weeks versus 17 weeks, p = 0.002). Most of the patients in their 3rd trimester pregnancy were subjected to OA. Operative time in LA cohort was shorter than in OA cohort (34 min. versus 44 min., p = 0.038). HLOS in LA cohort was shorter than in OA cohort (2.1 days versus 2.9 days, p = 0.016). There were no differences between OA and LA cohorts in terms of surgical complications or obstetrical outcomes. CONCLUSIONS Laparoscopic appendectomy for acute appendicitis was associated with a significantly shorter operative time and a shorter hospital length of stay while open and laparoscopic appendectomy cohorts experienced comparable obstetrical outcomes. Our findings support the laparoscopic approach for acute appendicitis in pregnancy.
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Affiliation(s)
- Edgar Lipping
- Division of Acute Care Surgery, North Estonia Medical Centre, J. Sütiste Tee 19, 13419, Tallinn, Estonia.
- Faculty of Medicine, University of Tartu, Tartu, Estonia.
| | - Sten Saar
- Division of Acute Care Surgery, North Estonia Medical Centre, J. Sütiste Tee 19, 13419, Tallinn, Estonia
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Kristiina Rull
- Faculty of Medicine, University of Tartu, Tartu, Estonia
- Division of Obstetrics and Gynecology, Tartu University Hospital, Tallinn, Estonia
| | - Airi Tark
- Centre of General and Oncological Surgery, East Tallinn Central Hospital, Tallinn, Estonia
| | - Mari Tiiman
- Division of Obstetrics and Gynecology, West Tallinn Central Hospital, Tallinn, Estonia
| | - Liis Jaanimäe
- Faculty of Medicine, University of Tartu, Tartu, Estonia
- Division of General and Plastic Surgery, Tartu University Hospital, Tartu, Estonia
| | - Urmas Lepner
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Peep Talving
- Division of Acute Care Surgery, North Estonia Medical Centre, J. Sütiste Tee 19, 13419, Tallinn, Estonia
- Faculty of Medicine, University of Tartu, Tartu, Estonia
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4
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Puljak L, Lund H. Definition, harms, and prevention of redundant systematic reviews. Syst Rev 2023; 12:63. [PMID: 37016459 PMCID: PMC10071231 DOI: 10.1186/s13643-023-02191-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Along with other types of research, it has been stated that the extent of redundancy in systematic reviews has reached epidemic proportions. However, it was also emphasized that not all duplication is bad, that replication in research is essential, and that it can help discover unfortunate behaviors of scientists. Thus, the question is how to define a redundant systematic review, the harmful consequences of such reviews, and what we could do to prevent the unnecessary amount of this redundancy. MAIN BODY There is no consensus definition of a redundant systematic review. Also, it needs to be defined what amount of overlap between systematic reviews is acceptable and not considered a redundancy. One needs to be aware that it is possible that the authors did not intend to create a redundant systematic review. A new review on an existing topic, which is not an update, is likely justified only when it can be shown that the previous review was inadequate, for example, due to suboptimal methodology. Redundant meta-analyses could have scientific, ethical, and economic questions for researchers and publishers, and thus, they should be avoided, if possible. Potential solutions for preventing redundant reviews include the following: (1) mandatory prospective registration of systematic reviews; (2) editors and peer reviewers rejecting duplicate/redundant and inadequate reviews; (3) modifying the reporting checklists for systematic reviews; (4) developing methods for evidence-based research (EBR) monitoring; (5) defining systematic reviews; (6) defining the conclusiveness of systematic reviews; (7) exploring interventions for the adoption of methodological advances; (8) killing off zombie reviews (i.e., abandoned registered reviews); (9) better prevention of duplicate reviews at the point of registration; (10) developing living systematic reviews; and (11) education of researchers. CONCLUSIONS Disproportionate redundancy of the same or very similar systematic reviews can lead to scientific, ethical, economic, and societal harms. While it is not realistic to expect that the creation of redundant systematic reviews can be completely prevented, some preventive measures could be tested and implemented to try to reduce the problem. Further methodological research and development in this field will be welcome.
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Affiliation(s)
- Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia.
| | - Hans Lund
- Section Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
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5
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Augustin G, Mikuš M, Bogdanic B, Barcot O, Herman M, Goldštajn MŠ, Tropea A, Vitale SG. A novel Appendicitis TriMOdal prediction Score (ATMOS) for acute appendicitis in pregnancy: a retrospective observational study. Updates Surg 2022; 74:1933-1941. [PMID: 36048362 DOI: 10.1007/s13304-022-01368-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 01/20/2023]
Abstract
Several scoring systems exist for the management of acute appendicitis (AA) during pregnancy. However, the systems are based on the nonpregnant adult population. The aim of this study was to create a highly accurate scoring system that can be applied to pregnant women and to compare it to the most commonly used scores in general population and pregnant women. The creation and subsequent implementation of a highly accurate score system could shorten the diagnostic period and minimize the use of (ionizing) diagnostic imaging allowing the selection of the best treatment approach in pregnant patients with acute appendicitis. A single-center, retrospective cohort observational study was conducted at the University Hospital Centre Zagreb, Zagreb, Croatia. Data were extracted from medical records of pregnant patients with suspected AA from January 2010 to December 2020. A total of 59 pregnant patients diagnosed with AA during pregnancy were identified, 41 were treated surgically, and 18 had non-surgical management. The main objective of our study was the detection of predictive factors of AA during pregnancy. Anorexia, pain migration to the right lower quadrant, rebound pain, axillary temperature over 37.3 °C, CRP/platelet ratio > 0.0422, neutrophil/lymphocyte ratio > 7.182, and ultrasonic signs of AA were scored. Scoring in Appendicitis TriMOdal Score (ATMOS) consists of positive clinical parameter, each bringing 1 point and other parameters mentioned above that bring 2 points each. The score ranges from 0 to 10. Our model of ATMOS yields a high area under the receiver-operating characteristic curve of 0.963. The positive likelihood ratio is 9.97 (95% CI 2.64-38.00), and the negative likelihood ratio is 0.1 (95% CI 0.03-0.31), meaning that 94% of cases with ATMOS > 4 have AA, while less than 13% with an ATMOS ≤ 4 have the diagnosis of AA. The potential of ATMOS differentiating AA during pregnancy was demonstrated. Future prospective, randomized trials are needed to evaluate its accuracy and whether it should be used instead of Alvarado or Tzanakis scores in clinical decision-making.Trial registration number ClinicalTrials.gov-NCT05202483. Date of registration: January 21, 2022.
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Affiliation(s)
- Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mislav Mikuš
- School of Medicine, University of Zagreb, Zagreb, Croatia.
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, 10000, Zagreb, Croatia.
| | - Branko Bogdanic
- Department of Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ognjen Barcot
- Department of Surgery, University Hospital Split, Spinčićeva 1, Split, Croatia
| | - Mislav Herman
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, 10000, Zagreb, Croatia
| | - Marina Šprem Goldštajn
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, 10000, Zagreb, Croatia
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via E. Tricomi 1, 90127, Palermo, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124, Catania, Italy
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Lunny C, Reid EK, Neelakant T, Chen A, Zhang JH, Shinger G, Stevens A, Tasnim S, Sadeghipouya S, Adams S, Zheng YW, Lin L, Yang PH, Dosanjh M, Ngsee P, Ellis U, Shea BJ, Wright JM. A new taxonomy was developed for overlap across 'overviews of systematic reviews': A meta-research study of research waste. Res Synth Methods 2022; 13:315-329. [PMID: 34927388 PMCID: PMC9303867 DOI: 10.1002/jrsm.1542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
Abstract
Multiple 'overviews of reviews' conducted on the same topic ("overlapping overviews") represent a waste of research resources and can confuse clinicians making decisions amongst competing treatments. We aimed to assess the frequency and characteristics of overlapping overviews. MEDLINE, Epistemonikos and Cochrane Database of Systematic Reviews were searched for overviews that: synthesized reviews of health interventions and conducted systematic searches. Overlap was defined as: duplication of PICO eligibility criteria, and not reported as an update nor a replication. We categorized overview topics according to 22 WHO ICD-10 medical classifications, overviews as broad or narrow in scope, and overlap as identical, nearly identical, partial, or subsumed. Subsummation was defined as when broad overviews subsumed the populations, interventions and at least one outcome of another overview. Of 541 overviews included, 169 (31%) overlapped across similar PICO, fell within 13 WHO ICD-10 medical classifications, and 62 topics. 148/169 (88%) overlapping overviews were broad in scope. Fifteen overviews were classified as having nearly identical overlap (9%); 123 partial overlap (73%), and 31 subsumed (18%) others. One third of overviews overlapped in content and a majority covered broad topic areas. A multiplicity of overviews on the same topic adds to the ongoing waste of research resources, time, and effort across medical disciplines. Authors of overviews can use this study and the sample of overviews to identify gaps in the evidence for future analysis, and topics that are already studied, which do not need to be duplicated.
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Affiliation(s)
- Carole Lunny
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Trish Neelakant
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Royal College of SurgeonsIreland
| | - Alyssa Chen
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Jia He Zhang
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Gavindeep Shinger
- Faculty of Pharmaceutical ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Adrienne Stevens
- Michael G. DeGroote Cochrane Canada Centre, Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityOntarioCanada
| | - Sara Tasnim
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Shadi Sadeghipouya
- Faculty of Pharmaceutical ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Stephen Adams
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Yi Wen Zheng
- Faculty of Pharmaceutical ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Lester Lin
- Faculty of Pharmaceutical ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Pei Hsuan Yang
- Faculty of Pharmaceutical ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Manpreet Dosanjh
- Faculty of Pharmaceutical ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Peter Ngsee
- Faculty of Pharmaceutical ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ursula Ellis
- Woodward LibraryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Beverley J. Shea
- Clinical Epidemiology ProgramOttawa Hospital Research Institute, University of OttawaOntarioCanada
| | - James M. Wright
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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7
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Puljak L, Parmelli E, Capobussi M, Gonzalez-Lorenzo M, Squizzato A, Moja L, Riva N. Mitigating Disputes Originated by Multiple Discordant Systematic Reviews and Meta-Analyses: A Survey of Methodologists and Clinicians. Front Res Metr Anal 2022; 7:849019. [PMID: 35494418 PMCID: PMC9051432 DOI: 10.3389/frma.2022.849019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Overlapping systematic reviews (SRs) are increasingly frequent in the medical literature. They can easily generate discordant evidence, as estimates of effect sizes and their interpretation might differ from one source to another. Objective To analyze how methodologists and clinicians make a decision when faced with discordant evidence formalized in structured tables. Methods We conducted a 16-item survey exploring how methodologists and clinicians would react when presented with multiple Summary of Findings (SoF) tables (generated using the GRADE tool) derived from 4 overlapping and discordant SRs and meta-analyses on thrombolytic therapy for intermediate-risk pulmonary embolism. SoF tables reported 4 different magnitudes of effects and overall certainty. Participants were asked to provide their recommendations regarding the intervention and the reasons behind their conclusion. Results Of the 80 invitees, 41 (51%) participated. The majority described themselves as "somewhat familiar" or experts with SoF tables. The majority recommended the therapy (pharmacological systemic thrombolysis), grading the recommendation as weak positive. Certainty of evidence and benefit-risk balance were the two criteria that prevailed in generating the recommendation. When faced with overlapping meta-analyses, the preferred approach was to use only high-quality SRs and exclude redundant SRs. Several participants suggested integrating the SoF tables with additional information, such as a more comprehensive evaluation of the risk of bias of systematic reviews (71%), heterogeneity/inconsistency (68%) and studies included within each SR (62%). Conclusion When faced with multiple controversial SR results, the type and completeness of reported information in SoF tables affect experts' ability to make recommendations. Developers of the SoF table should consider collating key information from overlapping and potentially discordant reviews.
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Affiliation(s)
- Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
| | - Elena Parmelli
- Department of Epidemiology, Lazio Region-ASL Roma 1, Rome, Italy
| | - Matteo Capobussi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Marien Gonzalez-Lorenzo
- Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Alessandro Squizzato
- Department of Medicine and Surgery, Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese, Italy
| | - Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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8
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Şahin B, Tinelli A, Augustin G. Are Cesarean Section and Appendectomy in Pregnancy and Puerperium Interrelated? A Cohort Study. Front Surg 2022; 9:819418. [PMID: 35252336 PMCID: PMC8891163 DOI: 10.3389/fsurg.2022.819418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction It is not known whether appendectomy for acute appendicitis (AA) increases the Cesarean section (CS) rate and whether CS increases the likelihood of AA and appendectomy in the early puerperium. In this study, delivery type and delivery outcomes and appendectomy during pregnancy and puerperium were analyzed. Methods This cross-sectional retrospective study was performed on 11,513 women, delivered during 2015–2020. Inclusion criteria were patients undergoing appendectomy for AA during pregnancy and the first 6 weeks after delivery. Evaluating parameters were age, parity, gestational week at birth, delivery type, and babies' birth weight. Results Thirty-two patients underwent appendectomy: 12 during pregnancy (2 in the first trimester, 6 in the second trimester, 4 in the third trimester) and 20 women during puerperium. 58.2% of pregnant women and 65% of puerperal women were submitted to CS. Discussion Half of the women who underwent appendectomy for AA during pregnancy may require urgent CS. The cause of acute abdomen in the postpartum period, especially in the first week, could be AA, especially in women delivered by CS.
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Affiliation(s)
- Banuhan Şahin
- Gynecology and Obstetrics Department, Amasya University Sabuncuoglu Serefeddin Training and Research Hospital, Amasya, Turkey
- *Correspondence: Banuhan Şahin
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (Centro di RIcerca Clinica SALentino), “Veris Delli Ponti Hospital”, Lecce, Italy
- Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Lecce, Italy
- Laboratory of Human Physiology, Faculty of Biological and Medical Physics, Phystech BioMed School, Moscow Institute of Physics and Technology (State University), Moscow Region, Russia
| | - Goran Augustin
- School of Medicine University of Zagreb, Zagreb, Croatia
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
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9
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Association of treatments for acute appendicitis with pregnancy outcomes in the United States from 2000 to 2016: Results from a multi-level analysis. PLoS One 2021; 16:e0260991. [PMID: 34898628 PMCID: PMC8668090 DOI: 10.1371/journal.pone.0260991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background Open appendectomy, laparoscopic appendectomy, and non-surgical treatment are three options to treat acute appendicitis during pregnancy. Previous studies on the association of different treatment methods for acute appendicitis with pregnancy outcomes have been limited by small sample sizes and residual confounding, especially with respect to hospital-level factors. This study aimed to investigate the association of treatment method for acute appendicitis with pregnancy outcomes using a multi-level analysis. Methods A retrospective cohort study was conducted based on a large electronic health records database in the United States during the period 2000 to 2016. All pregnancies diagnosed with acute appendicitis and treated in participating hospitals during the study period were included. We conducted multi-level hierarchical logistic regression to analyze both individual- and hospital-level factors for abortion, preterm labor, and cesarean section. Results A total of 10,271 acute appendicitis during pregnancy were identified during the study period. Of them, 5,872 (57.2%) were treated by laparoscopic appendectomy, 1,403 (13.7%) by open appendectomy, and 2,996 (29.2%) by non-surgical treatment. Compared with open appendectomy, both laparoscopic appendectomy (adjusted OR, 0.6, 95% CI, 0.4, 0.9) and non-surgical treatment (adjusted OR, 0.4; 95% CI, 0.3–0.7) showed a decreased risk of preterm labor. Other important individual-level determinants of adverse pregnancy outcomes included maternal age, gestational hypertension, and anemia during pregnancy, the hospital-level determinant included the number of beds. Conclusions Compared with open appendectomy, both laparoscopic appendectomy and non-surgical treatment may be associated with a lower risk of preterm labor, without increased risks of abortion and cesarean section.
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Puljak L. Delays in publishing systematic review registrations in PROSPERO are hindering transparency and may lead to research waste. BMJ Evid Based Med 2021; 26:e4. [PMID: 32665222 DOI: 10.1136/bmjebm-2020-111474] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Livia Puljak
- Catholic University of Croatia, Zagreb 10000, Croatia
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Olutoye OA, Style C, Menchaca A. Neurocognitive Effects of Fetal Exposure to Anesthesia. Anesthesiol Clin 2021; 39:851-869. [PMID: 34776113 DOI: 10.1016/j.anclin.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surgery during pregnancy occurs when maternal or fetal needs outweigh the status quo, yet much uncertainty remains regarding the effects of anesthesia and surgery on fetal neurodevelopment. This article will review common maternal and fetal indications for invasive procedures, along with contemporary research on fetal neurodevelopment following anesthesia and surgery, focusing on future areas of investigation.
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Affiliation(s)
- Olutoyin A Olutoye
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Suite A-3300, Houston, TX 77030, USA.
| | - Candace Style
- Abigail Wexner Research Institute, Center for Regenerative Medicine, Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43205, USA
| | - Alicia Menchaca
- Abigail Wexner Research Institute, Center for Regenerative Medicine, Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43205, USA
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Tian J, Wu S, Dong L, Tang H. Pharmacological and non-pharmacological interventions for osteoporosis: A protocol for an overview with an evidence map and a network meta-analysis of trials. Medicine (Baltimore) 2021; 100:e26429. [PMID: 34128909 PMCID: PMC8213325 DOI: 10.1097/md.0000000000026429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Osteoporosis is a common bone disease that has a significant social and economic effect. Many meta-analyses of pharmacological and non-pharmacological treatments for osteoporosis have been reported, but the findings may be contradictory, and both the reporting and methodological quality remain unknown. As a result, an overview that includes a network meta-analysis was proposed to address these issues. METHODS The Cochrane library, PubMed, Embase, CBM, and CNKI databases will be systematically searched for meta-analyses of osteoporosis interventions from inception to May 2021. In order to evaluate the reporting and methodological quality of each included meta-analysis, Preferred Reporting Items for Systematic Review and Meta-analysis 2020 (PRISMA-2020), and A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) will be used. For the assessment of the relative efficacy and safety of treatments reported in the randomized controlled trials included in the meta-analyses identified by the overview, a Bayesian network meta-analysis will be carried out. The odds ratio and standard mean difference with their 95% credible intervals will be used to present the binary and continuous outcomes, respectively, and the Grading of Recommendations Assessment, Development and Evaluation method will be used to determine the certainty of the evidence through Confidence In Network Meta-Analysis. Data analysis will be performed using WinBUGS, R, and Stata, with a 2-sided P < .05 considered as statistically significant. RESULTS The findings of this overview, which includes a network meta-analysis, will be submitted to a peer-reviewed journal for publication. CONCLUSION An overview with network meta-analysis will provide evidence on the efficacy and safety of pharmacological and non-pharmacological interventions for osteoporosis, while also identifying the flaws in previously published meta-analyses. All of these results may be used to improve clinical decision-making and future studies. INPLASY REGISTRATION NUMBER INPLASY202150022.
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Affiliation(s)
- Jidong Tian
- Gansu Provincial Hospital of Traditional Chinese Medicine
| | - Shuo Wu
- The First People's Hospital of Jiayuguan City, Jiayuguan, Gansu
| | - Lin Dong
- Gansu Provincial Hospital of Traditional Chinese Medicine
| | - Hao Tang
- Clinical College of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou, China
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