BACKGROUND: The surgeon volume-outcome relationship has been discussed for many years and its existence or nonexistence is of importance for various reasons. A lot of empirical work has been published on it. We aimed to summarize systematic reviews in order to present current evidence.
METHODS: Medline, Embase, Cochrane database of systematic reviews (CDSR), and health technology assessment websites were searched up to October 2015 for systematic reviews on the surgeon volume-outcome relationship. Reviews were critically appraised, and results were extracted and synthesized by type of surgical procedure/condition.
RESULTS: Thirty-two reviews reporting on 15 surgical procedures/conditions were included. Methodological quality of included systematic reviews assessed with the assessment of multiple systematic reviews (AMSTAR) was generally moderate to high albeit included literature partly neglected considering methodological issues specific to volume-outcome relationship. Most reviews tend to support the presence of a surgeon volume-outcome relationship. This is most clear-cut in colorectal cancer, bariatric surgery, and breast cancer where reviews of high quality show large effects.
CONCLUSIONS: When taking into account its limitations, this overview can serve as an informational basis for decision makers. Our results seem to support a positive volume-outcome relationship for most procedures/conditions. However, forthcoming reviews should pay more attention to methodology specific to volume-outcome relationship. Due to the lack of information, any numerical recommendations for minimum volume thresholds are not possible. Further research is needed for this issue.
L'étude visait à trouver des preuves scientifiques sur la durée de la cessation du tabagisme préopératoire nécessaire pour réduire la plaie de guérison des complications chirurgicales. Un examen d'intégration a été effectuée dans les bases de données, la littérature latino-américaine et des Caraïbes sur les sciences de la santé (LILACS) et médicale Analyse littérature et Retrieval System Online (MEDLINE), du 17/08/2012 au 17/09/2012, en utilisant les mots-clés: tabac utiliser la cessation et la cicatrisation des plaies; renoncement au tabac et la période préopératoire; renoncement au tabac et la période périopératoire (LILACS) et l'utilisation de l'abandon du tabac et de la période périopératoire; l'usage du tabac cessation et la cicatrisation des plaies (MEDLINE). Sur les 81 études admissibles, 12 ont été inclus. La durée de la cessation du tabagisme nécessaire pour réduire les complications de guérison était au moins quatre semaines (quatre études de niveau de preuve I, trois études de niveau de preuve II, deux études de niveau de preuve IV, et une étude avec le niveau de la preuve VII).
BACKGROUND: Pharmacologic thromboprophylaxis reduces the risk for venous thromboembolism after total hip replacement (THR) or total knee replacement (TKR). New oral anticoagulants (NOACs), including direct thrombin inhibitors and factor Xa inhibitors, are emerging options for thromboprophylaxis after these procedures.
PURPOSE: To compare the benefits and risks of NOACs versus standard thromboprophylaxis for adults having THR or TKR.
DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from January 2009 through March 2013.
STUDY SELECTION: English-language systematic reviews.
DATA EXTRACTION: Two independent reviewers abstracted data and rated study quality and strength of evidence.
DATA SYNTHESIS: Six good-quality systematic reviews compared NOACs with low-molecular-weight heparin (LMWH) for thromboprophylaxis after THR or TKR. Risk for symptomatic deep venous thrombosis, but not risk for death or nonfatal pulmonary embolism, was reduced with factor Xa inhibitors compared with LMWH (4 fewer events per 1000 patients). Conversely, the risk for major bleeding increased (2 more events per 1000 patients). Outcomes of dabigatran did not significantly differ from those of LMWH. Indirect evaluation of NOACs by common comparison with LMWH showed nonsignificantly reduced risks for venous thromboembolism with rivaroxaban compared with dabigatran (risk ratio [RR], 0.68 [95% CI, 0.21 to 2.23]) and apixaban (RR, 0.59 [CI, 0.26 to 1.33]) but increased major bleeding. New oral anticoagulants have not been compared with warfarin, aspirin, or unfractionated heparin.
LIMITATIONS: Head-to-head comparisons among NOACs were not available. Efficacy is uncertain in routine clinical practice.
CONCLUSION: New oral anticoagulants are effective for thromboprophylaxis after THR and TKR. Their clinical benefits over LMWH are marginal and offset by increased risk for major bleeding.
PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.
Norwegian Knowledge Centre for the Health Services has on request from Lovisenberg Diakonale Hospital reviewed the scientific evidence on the effect of graduated compression stockings (GCS) for prevention of deep vein thrombosis (DVT) among surgical and medical patients in hospitals.
Systematic literature search was carried out in relevant medical databases. We included tree systematic reviews. The systematic reviews had moderately to high methodological quality.
The evidence indicates that GCS prevents the formation of DVT among surgical patients, both alone and on a background of other prophylactic methods. It seems that knee length GCS is as effective in prevention of DVT as thigh length GCS. The evidence of GCS for prevention of DVT is less conclusive regarding medical patients.
Use of GCS also prevents development of post thrombotic syndrome, i.e. a condition that can occur after DVT.
Further research is necessary to identify which compression graduate is more effective and duration of time that GCS should be worn to prevent DVT.
The surgeon volume-outcome relationship has been discussed for many years and its existence or nonexistence is of importance for various reasons. A lot of empirical work has been published on it. We aimed to summarize systematic reviews in order to present current evidence.
METHODS:
Medline, Embase, Cochrane database of systematic reviews (CDSR), and health technology assessment websites were searched up to October 2015 for systematic reviews on the surgeon volume-outcome relationship. Reviews were critically appraised, and results were extracted and synthesized by type of surgical procedure/condition.
RESULTS:
Thirty-two reviews reporting on 15 surgical procedures/conditions were included. Methodological quality of included systematic reviews assessed with the assessment of multiple systematic reviews (AMSTAR) was generally moderate to high albeit included literature partly neglected considering methodological issues specific to volume-outcome relationship. Most reviews tend to support the presence of a surgeon volume-outcome relationship. This is most clear-cut in colorectal cancer, bariatric surgery, and breast cancer where reviews of high quality show large effects.
CONCLUSIONS:
When taking into account its limitations, this overview can serve as an informational basis for decision makers. Our results seem to support a positive volume-outcome relationship for most procedures/conditions. However, forthcoming reviews should pay more attention to methodology specific to volume-outcome relationship. Due to the lack of information, any numerical recommendations for minimum volume thresholds are not possible. Further research is needed for this issue.
