bluuebunny/crossref_metadata_2025_split huggingface dataset:
593 Colonic Perforation Following Major Burns: A Systematic Review
Authors: Fadel M , Iskandarani M , Cuddihy J , Jones I , Collins D , Kontovounisios C 
Published: October 2021

Abstract

Introduction
Major burns complicated by stress ulceration and perforation of the stomach or duodenum is a recognised clinical phenomenon. Colonic perforation in burns patients is seemingly uncommon, and the overall incidence, clinical signs/diagnosis of perforation, intervention required, and mortality is incompletely described in the literature.

Method
We performed a systematic review of the literature on severe burns resulting in colonic perforation during admission. Relevant studies from January 1975 to June 2020 were retrieved from MEDLINE and EMBASE databases. Patient demographics, total body surface area (TBSA), site of colonic perforation, management and overall outcome were extracted. We present a case series of five major burns patients who had colonic perforations in our Specialist Burns Centre.

Results
We identified 54 studies, of which nine (two case series and seven case reports) met the inclusion criteria. In most cases, the TBSA associated with a colonic perforation was ≥ 30% (10/16 patients, 63%) and the abdomen was involved in 9/16 patients (56%). Perforations mainly affected the right colon (12/16 patients, 75%), usually occurring after the second week of admission (13/16 patients, 81%). Right-sided colonic perforations were associated with an increased mortality rate compared to left-sided perforations (42% vs 25%).

Conclusions
The current literature, mainly limited to case series and case reports, confirms that colonic perforations in burns patients are rare. The resulting perforation is related to the systemic effect of burn injuries including sepsis and gastrointestinal stasis. We have identified patients who are at higher risk of developing colonic perforations in order to prompt early diagnosis and intervention.
628 Management of Chyle Leaks Following Oesophagectomy: A Systematic Review
Authors: Power R , Smyth P , Donlon N E , Nugent T , Donohoe C L , Reynolds J V 
Published: October 2021

Abstract

Aim
Chyle leakage is a rare but potentially life-threatening complication following oesophageal resection. The optimal management strategy is not clear.

Method
Searches were conducted up to 31/12/2020 on MEDLINE, Embase and Web of Science for randomised trials or retrospective studies that evaluated the management of chyle leakage following oesophageal resection. Two authors independently screened studies extracted data and assessed for bias. The protocol was prospectively registered on PROSPERO (CRD: 42021224895) and reported in accordance with PRISMA guidelines.

Results
A total of 530 citations were reviewed. Twenty-five studies, totaling 1016 patients met the inclusion criteria, including 2 low-quality clinical trials and 23 retrospective case series. Heterogeneity of study design and outcomes prevented meta-analysis. The overall incidence of chyle leaks was 3.2% but no consistent risk factors were found across studies. Eighteen studies describe management of chyle leaks conservatively, 17 by surgical ligation of the thoracic duct, and 6 described percutaneous lymphangiography with thoracic duct embolisation (TDE) or disruption (TDD). There is a paucity of high-quality prospective studies directly comparing treatment modalities, but there is some low-certainty evidence that percutaneous approaches have reduced morbidity, but lower efficacy compared to surgery.

Conclusions
The evidence-base for optimal management of chyle leakage post-oesophagectomy is lacking, which may be related to its low incidence. Further high quality, prospective studies that compare interventions at different levels of severity are needed to determine the optimal approach to treatment.
697 The Use of Augmented and Mixed Reality Technology to Improve Surgical Outcomes: A Systematic Review
Authors: Bollen E , Solomon J , Stubbs M , Langridge B , Butler P E M 
Published: October 2021

Abstract

Aim
The use of augmented and mixed reality technology is a novel and rapidly developing field. This technology has generated significant interest in surgery, however the evidence supporting its proposed benefits is limited. This systematic review aims to critically appraise the intraoperative use of augmented and mixed reality technology to improve surgical outcomes in order to provide directions for future research.

Method
This systematic review is registered with PROSPERO (CRD42020205892) and was performed in adherence to PRISMA guidelines. Studies reporting primary data on surgical outcomes of the intraoperative use of augmented and mixed reality technology were included. A structured search of major literature databases was performed. Risk of bias was assessed following the guidance of the Cochrane Handbook.

Results
68 studies met the inclusion criteria, with 63 reporting the intraoperative use of augmented reality technology and 5 reporting the use of mixed reality. The number and methodological quality of these studies is increasing. The intraoperative use of this technology has been demonstrated to reduce operative times, intraoperative blood loss and lengths of hospital admissions in specific settings. The widespread adoption of this technology faces the challenges of its cost, technical precision and integration into the surgical workflow.

Conclusions
The intraoperative use of augmented and mixed reality technology is an area of research still in its early stages, with an increasing number of methodologically robust studies on the subject. Current results suggest that the use of this technology is safe and, in certain applications, has the potential to significantly improve surgical and health-economic outcomes.
720 Pringle Versus Selective Hepatic Vascular Exclusion in Major Hepatectomy: A Systematic Review and Meta-Analysis
Authors: Mobarak S , Stott M , Tarazi M , Varley R , Davé M , Baltatzis M , Satyadas T 
Published: October 2021

Abstract

Aim
Mortality and morbidity following hepatic resection is significantly affected by major intra-operative blood loss. Multiple techniques have been developed in an attempt to minimise blood loss by occluding hepatic inflow and outflow. This systematic review and meta-analysis evaluates whether selective hepatic vascular exclusion compared to a Pringle manoeuvre in hepatic resection reduces rates of morbidity and mortality.

Method
A systematic review and meta-analysis were conducted according to the PRISMA guidelines by screening EMBASE, MEDLINE/PubMed, CENTRAL, SCOPUS and bibliographic reference lists for comparative studies meeting the predetermined inclusion criteria. Intra- and post-operative outcome measures were investigated. Pooled odds ratios or mean differences with 95% confidence intervals were calculated using either fixed- or random-effects models.

Results
Five studies were identified including two randomized controlled trials and three observational studies reporting a total of 2,198 patients. Data synthesis showed significantly decreased rates of mortality, overall complications, patients requiring blood transfusion, air embolism, warm ischaemia time, liver failure and multi-organ failure when performing SHVE compared to a Pringle manoeuvre. Rates of hepatic vein rupture and post-operative haemorrhage remained the same. Performing SHVE resulted in a significantly longer operation time.

Conclusions
Performing SHVE in major hepatectomy may result in reduced rates of morbidity and mortality when compared to a Pringle manoeuvre, although may prolong operating time. The results of this meta-analysis are based on a few high-quality studies where tumours were adjacent to major vessels. Further RCTs are required to validate these results and determine the best technique for hepatic vascular control in this patient cohort.
724 Quadriceps Tendon Autograft Versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Repair: A Systematic Review and Meta-Analysis
Authors: Tan T K , Subramaniam A G , Radic R 
Published: October 2021

Abstract

Aim
Quadriceps tendon (QT) autograft has recently become the popular choice of autograft in anterior cruciate ligament reconstruction (ACLR) and slowly replacing hamstring tendon (HT) autograft. QT autograft has traditionally served as the alternative of HT autograft, but recent studies revealed that QT autografts are not inferior to HT autografts. The purpose of this study was to provide an in-depth review the clinical and functional outcomes between QT and HT autografts in ACLR.

Method
Databases of Pubmed, EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until November 2020. All observational studies comparing QT and HT autografts in the ACRL surgery were included.

Results
Twenty-two observational studies (3 randomized controlled trials and 19 comparative studies) comprising of 16952 patients (QT = 1407, HT = 15545) were included in quantitative meta-analysis. In comparison to HT autograft, patients who received QT autograft had similar postoperative Lysholm Score (MD:1.05, p = 0.44), Tegner Score (MD:0.11, p = 0.06), IKDC score (MD:0.48, p = 0.48), side to side laxity(MD:-0.08, p = 0.77), limb symmetry index (MD:1.87, p = 0.61), Pivot shift test grade 0 (OR:1.13, p = 0.74), Lachman test grade 0 (OR:2.38, p = 0.32), hamstring to quadriceps ratio (MD:-1.10, p = 0.82), incidence of graft failure (OR:0.68, p = 0.43), contralateral knee injury (OR:1.22, p = 0.61), peak torque muscle strength flexion (MD:-0.20, ρ = 0.10) and Cincinnati score (MD:-0.85, p = 0.66).

Conclusions
In this meta-analysis, the usage of QT autograft is not inferior to HT autograft in ACLR. Our study demonstrated comparable morbidity, clinical and functional outcome in QT and HT autografts, indicating that QT autograft is equally safe as HT autograft.
728 A Systematic Review of The Efficacy and Safety of Outpatient Bladder Tumour Ablation
Authors: Malde S , Grover S , Raj S , Yuan C , Nair R , Thurairaja R , Khan M S 
Published: October 2021

Abstract

Introduction
The management of recurrent non-muscle-invasive bladder cancer (NMIBC) typically requires repeated transurethral resections under general anaesthesia. This is costly and results in poor health-related quality-of-life for patients. Outpatient-based laser ablation and diathermy to recurrent tumours could reduce morbidity and cost of managing NMIBC. This systematic review evaluates the safety and efficacy of outpatient-based diathermy or laser ablation for recurrent NMIBC.

Method
The EMBASE, MEDLINE and Cochrane Library were searched until June 2020. All studies evaluating the use of outpatient diathermy or laser ablation for NMIBC were included. The quality of evidence and risk of bias were assessed using the GRADE and ROBINS-I tools, respectively.

Results
From 1328 studies identified, 17 studies (1584 patients) were included. Overall, the majority of tumours (80%) were low-grade (G1 and G2). Laser ablation and diathermy resulted in a mean recurrence rate of 47% and 40% at 20-31 months follow-up, respectively, with a mean progression rate of 3-11%. Both procedures were well-tolerated with low pain scores (mean score of 1) and low periprocedural complication rates. However, the overall quality of evidence of low.

Conclusions
This review demonstrates that both procedures have good short-term efficacy in patients with low-grade NMIBC. The procedures are well-tolerated with low complication rates and importantly, reduce the need for intervention under general anaesthesia. These findings can aid patient counselling regarding less invasive treatment options, avoiding the morbidity of transurethral resection. Future randomised studies with standardised risk stratification and outcome measures are required to add to the quality of evidence.
810 Intravenous Iron Versus Oral Iron in Anemia Management for Perioperative Patients: A Systemic Review and Meta-Analysis
Authors: Alshantti A 
Published: October 2021

Abstract

Introduction
Perioperative anemia commonly occurs in patients undoing major surgery. We aimed to assess the efficacy and safety of intravenous iron therapy (IVIT) given compared to standard practice of oral iron in the perioperative period.

Design
The search strategy was conducted in Medline, Embase, and Cochrane for only eligible clinical trials (randomized controlled trials) comparing IV over oral iron therapy up to July 2019. The primary outcome was the effect of IVIT on the change of hemoglobin level. The secondary outcomes were the effects of IVIT compared to oral iron on ferritin level, mean corpuscular volume, and adverse side effects. Data were collected from each trial and where applicable meta-analyzed using RevMan.

Results
Six randomized clinical trials that fit our inclusion criteria were included in the study.We found that IVIT increases the level of hemoglobin compared to oral iron (MD: Mean difference 0.90, 95% confidence interval [CI]: 0.44–1.36, P = 0.000). Serum ferritin levels increased significantly in favor of the IV iron group compared to the oral iron group at posttreatment (MD: 106.95, 95% CI: 73.29, 140.62 ng/mL). In addition, marked increases in the pooled mean corpuscular volume (MCV) level were observed in favor of the IVIT (MD: 6.07, 95% CI: −0.88–13.02). There was no significant difference in the rate of adverse effects in both the groups.

Conclusions
IV iron therapy is more effective than oral iron on increasing hemoglobin, ferritin, and MCV in the perioperative period and is also as safe with no diffidence in the risk of developing adverse side effects.
863 Online Patient Resources to Support Shared Decision Making for Fundoplication Surgery: A Systematic Review
Authors: Virupaksha S 
Published: October 2021

Abstract

Aim
The royal college of Surgeons’ Supported Decision-Making guidance details how patients should access information necessary to make clinical decisions alongside their medical team. As patients become more reliant on information found via the internet, it is important to ensure that there are suitable, validated, and appropriate resources. This study aims to assess the quality of online patient information related to anti reflux (Fundoplication) surgery and we believe this review is first of its kind with regards to surgery for gastroesophageal reflux disease.

Method
A comprehensive, targeted search was made of online healthcare information relating to Fundoplication surgery. Search terms ‘fundoplication’ and ‘anti-reflux surgery’ were entered into three main search engines using a pre-defined search strategy. Websites were assessed according to their readability (Klesch-Kincaid Reading Ease Score), quality and content (International Patient Decision Aids Standards (IPDAS) and DISCERN scores) as well as the presence of accreditation. The PRISM and AMSTAR guidelines have been followed in this article.

Results
Overall, 74 sources from three search engines were found. Duplicates were removed and pre-defined eligibility criteria applied, giving 40 sources for analysis. The mean readability score was higher than the recommended score for patient education materials, while the IPDAS and DISCERN scores were low. There were only 22.5% of the websites accredited by the HANcode. No statistical significance was found on the overall quality of websites between the accredited and non-accredited websites

Conclusions
Patient information available online for fundoplication is difficult to read and of poor quality impacting negatively on shared decision-making.
866 The Use of Deep Learning for The Detection, Characterisation and Prediction of Metastatic Disease From CT: A Systematic Review
Authors: Shivakumar N , Chandrashekar A , Handa A , Lee R 
Published: October 2021

Abstract

Introduction
Computed tomography (CT) is widely used in the clinical setting for the diagnosis, staging and management of cancer. The presence of metastatic disease in cancer has significant implications on most effective treatment options as well as prognosis. With advances in computing technology, deep learning - a form of machine learning - where layers of programmed algorithms are able interpret and recognise patterns may have a potential role in CT image analysis. This review aims to provide an overview on the use of deep learning in CT image analysis in the diagnostic evaluation of metastatic disease.

Method
A systematic search on databases Medline, Embase and Central was performed. Retrieved studies were screened as per the inclusion and exclusion criteria. A total of 29 studies were included for which a narrative synthesis was provided

Results
With regards to metastatic disease, the studies could be grouped together into three areas of research. Firstly, the use of deep learning on the detection of metastatic disease from CT imaging. Secondly, its use on the characterisation of lesions on CT into metastatic disease. Finally, the use of deep learning to predict the presence or development of metastatic disease based on the primary tumour.

Conclusions
Deep learning in CT image analysis could have a potential role in evaluating metastatic disease, however, prospective clinical trials investigating its clinical value is required.
1020 Delay to Surgery in Acute Perforated and Ischaemic Gastrointestinal Pathology
Authors: Murray V , Burke J , Hughes M , Schofield C , Young A 
Published: October 2021

Abstract

Introduction
Patients with acute abdominal pathology requiring emergency laparotomy who experience a delay to theatre have an increased risk of morbidity, mortality, and complications. The timeline between symptom onset and operation is ill-defined with international variance in assessment and management. This systematic review aims to define where delays to surgery occur and assess the evidence for previous interventions.

Method
A systematic review was performed searching MEDLINE and EMBASE databases (January 1st 2005 to May 6th 2020). All studies assessing the impact of time to theatre in patients with acute abdominal pathology requiring emergency laparotomy were considered.

Results
Eighty-five results were assessed to include 19 papers in the analysis. Fifteen unique timepoints were identified in the patient pathway between symptom onset and operation which could be classified into four distinct phases. Time from admission to theatre (1 to 72 hours), and mortality rate (10.6-74.5%) varied greatly between studies. Mean time to surgery was significantly higher in deceased patients compared to survivors. Delays were related to imaging, diagnosis, decision-making, theatre availability and staffing. Four of five interventional studies showed a reduced mortality following introduction of an acute laparotomy pathway.

Conclusions
There is wide variation in the definition and measurement of time delays prior to emergency surgery with few studies exploring interventions. Given the heterogenous nature of the patient population and pathologies, an assessment and management framework from onset of symptoms to operation is proposed. This could be incorporated into national mortality prediction and audit tools and assist in the assessment of interventions.
1070 A Systematic Review of Seymour Fracture Management
Authors: Khanal P , Srivastava A , Zargaran D , Zargaran A , Nikkhah D , Mosahebi A 
Published: October 2021

Abstract

Aim
Seymour fractures are distal phalanx fractures of the finger in children with a juxta-epiphyseal or Salter-Harris Type I/II pattern associated with a nail-bed injury. There remains a paucity in literature regarding the development of complications between Seymour fracture management options, with early studies encouraging non-operative management due to the increased rates of post-operative infection. This systematic review aims to identify present-day, optimal management strategies for Seymour fractures, with further analysis of infection rates and secondary outcomes during post-operative recovery.

Method
Free-text search, MeSH terms and expanded keywords/phrases were employed to search the PubMed, Embase (via Ovid), Web of Science and CINAHL databases. Studies that described the management of Seymour fractures in paediatric patients were included, subject to inclusion/exclusion criteria. The data extracted included the sample size, intervention, infection rates and secondary outcomes.

Results
An initial search identified 305 articles, following the PRISMA guidance, 8 studies were eligible for full-text analysis. Across all studies, 307 Seymour fractures were identified (mean age, 10±1.2 years). A cross-study analysis showed a lower rate of adverse outcomes (including malunion/non-union and unplanned operative intervention) for K-wire fixation when compared to external splinting, 8.3% and 20.7% (P ≤ 0.001), respectively.

Conclusions
There was no statistically significant difference between non-operative and operative management in rates of infection and adverse outcomes. However, further analysis revealed a significantly lower risk of complications in patients who received K-wire fixation when compared to external splinting. Nonetheless, further studies with greater levels of evidence need to be carried out to consolidate this.
1136 Cochlear Implant Outcomes in Patients with Otosclerosis: A Systematic Review
Authors: Lam C M , Cornwall H L , Chaudhry A , Muzaffar J , Bance M , Monksfield P 
Published: October 2021

Abstract

Introduction
In otosclerosis, spongiotic bone replaces normal bone in the ossicular chain. Focal deposits may also be found within the cochlea leading to sensorineural hearing loss refractory to conventional treatment. Cochlear implantation can play an important role in the management of otosclerosis in these patients. Our study objective is to establish hearing outcomes following cochlear implantation in patients with otosclerosis.

Method
Systematic review and narrative synthesis. Databases searched: Medline, PubMed, Embase, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on language or year of publication. Review conducted in accordance with the PRISMA statement.

Results
Searches identified 68 studies meeting the inclusion criteria and reporting outcomes in a minimum of 481 patients with at least 516 implants. The methodological quality of included studies was modest, predominantly consisting of case reports and non-controlled case series with small numbers of patients. Significant heterogeneity existed in terms of outcomes and methods of reporting, which precluded a meta-analysis. Access to good rehabilitation support is essential to achieving the good hearing outcomes and Patient Reported Outcome Measures that can be expected by 12 months post-implantation in most cases. There was significant association between the radiological severity of otosclerosis and an increase in surgical and post-operative complications. Post-operative facial nerve stimulation can occur and may require deactivation of electrodes and subsequent hearing detriment.

Conclusions
Hearing outcomes are typically good, but patients should be counselled on associated surgical complications which may compromise hearing. Modern diagnostic techniques may help to identify potentially difficult cases to aid operative planning and patient counselling.