释放TIPS作为肝硬化患者选择性和紧急手术的桥梁的潜力:一项荟萃分析和急性护理手术血管内复苏的未来方向

IF 6 1区医学 Q1 EMERGENCY MEDICINE

World Journal of Emergency Surgery Pub Date : 2023-04-17 DOI:10.1186/s13017-023-00498-4

Ramiro Manzano-Nunez, Alba Jimenez-Masip, Julian Chica-Yanten, Abdelaziz Ibn-Abdelouahab, Massimo Sartelli, Nicola de'Angelis, Ernest E Moore, Alberto F García

{"title":"释放TIPS作为肝硬化患者选择性和紧急手术的桥梁的潜力:一项荟萃分析和急性护理手术血管内复苏的未来方向","authors":"Ramiro Manzano-Nunez, Alba Jimenez-Masip, Julian Chica-Yanten, Abdelaziz Ibn-Abdelouahab, Massimo Sartelli, Nicola de'Angelis, Ernest E Moore, Alberto F García","doi":"10.1186/s13017-023-00498-4","DOIUrl":null,"url":null,"abstract":"Background: In this systematic review and meta-analysis, we examined the evidence on transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to elective and emergency surgery in cirrhotic patients. We aimed to assess the perioperative characteristics, management approaches, and outcomes of this intervention, which is used to achieve portal decompression and enable the safe performance of elective and emergent surgery.Methods: MEDLINE and Scopus were searched for studies reporting the outcomes of cirrhotic patients undergoing elective and emergency surgery with preoperative TIPS. The risk of bias was evaluated using the methodological index for non-randomized studies of interventions, and the JBI critical appraisal tool for case reports. The outcomes of interest were: 1. Surgery after TIPS; 2. Mortality; 3. Perioperative transfusions; and 4. Postoperative liver-related events. A DerSimonian and Laird (random-effects) model was used to perform the meta-analyses in which the overall (combined) effect estimate was presented in the form of an odds ratio (summary statistic).Results: Of 426 patients (from 27 articles), 256 (60.1%) underwent preoperative TIPS. Random effects MA showed significantly lower odds of postoperative ascites with preoperative TIPS (OR = 0.40, 95% CI 0.22-0.72; I2 = 0%). There were no significant differences in 90-day mortality (3 studies: OR = 0.76, 95% CI 0.33-1.77; I2 = 18.2%), perioperative transfusion requirement (3 studies: OR = 0.89, 95% CI 0.28-2,84; I2 = 70.1%), postoperative hepatic encephalopathy (2 studies: OR = 0.97, 95% CI 0.35-2.69; I2 = 0%), and postoperative ACLF (3 studies: OR = 1.02, 95% CI 0.15-6.8, I2 = 78.9%).Conclusions: Preoperative TIPS appears safe in cirrhotic patients who undergo elective and emergency surgery and may have a potential role in postoperative ascites control. Future randomized clinical trials should test these preliminary results.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"30"},"PeriodicalIF":6.0000,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10111768/pdf/","citationCount":"2","resultStr":"{\"title\":\"Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery.\",\"authors\":\"Ramiro Manzano-Nunez, Alba Jimenez-Masip, Julian Chica-Yanten, Abdelaziz Ibn-Abdelouahab, Massimo Sartelli, Nicola de'Angelis, Ernest E Moore, Alberto F García\",\"doi\":\"10.1186/s13017-023-00498-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: In this systematic review and meta-analysis, we examined the evidence on transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to elective and emergency surgery in cirrhotic patients. We aimed to assess the perioperative characteristics, management approaches, and outcomes of this intervention, which is used to achieve portal decompression and enable the safe performance of elective and emergent surgery.Methods: MEDLINE and Scopus were searched for studies reporting the outcomes of cirrhotic patients undergoing elective and emergency surgery with preoperative TIPS. The risk of bias was evaluated using the methodological index for non-randomized studies of interventions, and the JBI critical appraisal tool for case reports. The outcomes of interest were: 1. Surgery after TIPS; 2. Mortality; 3. Perioperative transfusions; and 4. Postoperative liver-related events. A DerSimonian and Laird (random-effects) model was used to perform the meta-analyses in which the overall (combined) effect estimate was presented in the form of an odds ratio (summary statistic).Results: Of 426 patients (from 27 articles), 256 (60.1%) underwent preoperative TIPS. Random effects MA showed significantly lower odds of postoperative ascites with preoperative TIPS (OR = 0.40, 95% CI 0.22-0.72; I2 = 0%). There were no significant differences in 90-day mortality (3 studies: OR = 0.76, 95% CI 0.33-1.77; I2 = 18.2%), perioperative transfusion requirement (3 studies: OR = 0.89, 95% CI 0.28-2,84; I2 = 70.1%), postoperative hepatic encephalopathy (2 studies: OR = 0.97, 95% CI 0.35-2.69; I2 = 0%), and postoperative ACLF (3 studies: OR = 1.02, 95% CI 0.15-6.8, I2 = 78.9%).Conclusions: Preoperative TIPS appears safe in cirrhotic patients who undergo elective and emergency surgery and may have a potential role in postoperative ascites control. Future randomized clinical trials should test these preliminary results.\",\"PeriodicalId\":48867,\"journal\":{\"name\":\"World Journal of Emergency Surgery\",\"volume\":\"18 1\",\"pages\":\"30\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2023-04-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10111768/pdf/\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Emergency Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13017-023-00498-4\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Emergency Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13017-023-00498-4","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}

引用次数: 2

摘要

背景:在这篇系统综述和荟萃分析中，我们研究了经颈静脉肝内门体分流术(TIPS)作为肝硬化患者择期和急诊手术的桥梁的证据。我们的目的是评估这种干预的围手术期特征、管理方法和结果，这种干预用于实现门静脉减压，并使选择性和紧急手术能够安全进行。方法:检索MEDLINE和Scopus中关于肝硬化患者择期和急诊手术术前TIPS的研究结果。使用干预措施的非随机研究的方法学指数和病例报告的JBI关键评估工具来评估偏倚风险。感兴趣的结果是:1。TIPS后手术;2. 死亡率;3.围手术期输血;和4。术后肝脏相关事件。使用DerSimonian和Laird(随机效应)模型进行meta分析，其中总体(组合)效应估计以优势比(汇总统计量)的形式呈现。结果:426例患者(来自27篇文章)中，256例(60.1%)接受了术前TIPS。随机效应MA显示术前TIPS术后腹水发生率显著低于术前TIPS (OR = 0.40, 95% CI 0.22-0.72;i2 = 0%)。90天死亡率无显著差异(3项研究:OR = 0.76, 95% CI 0.33-1.77;I2 = 18.2%)，围手术期输血需求(3项研究:OR = 0.89, 95% CI 0.28-2,84;I2 = 70.1%)，术后肝性脑病(2项研究:OR = 0.97, 95% CI 0.35-2.69;I2 = 0%)和术后ACLF(3项研究:OR = 1.02, 95% CI 0.15-6.8, I2 = 78.9%)。结论:对于接受选择性和紧急手术的肝硬化患者，术前TIPS似乎是安全的，并可能在术后腹水控制中发挥潜在作用。未来的随机临床试验应该检验这些初步结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery.

查看原文本刊更多论文

Background: In this systematic review and meta-analysis, we examined the evidence on transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to elective and emergency surgery in cirrhotic patients. We aimed to assess the perioperative characteristics, management approaches, and outcomes of this intervention, which is used to achieve portal decompression and enable the safe performance of elective and emergent surgery.

Methods: MEDLINE and Scopus were searched for studies reporting the outcomes of cirrhotic patients undergoing elective and emergency surgery with preoperative TIPS. The risk of bias was evaluated using the methodological index for non-randomized studies of interventions, and the JBI critical appraisal tool for case reports. The outcomes of interest were: 1. Surgery after TIPS; 2. Mortality; 3. Perioperative transfusions; and 4. Postoperative liver-related events. A DerSimonian and Laird (random-effects) model was used to perform the meta-analyses in which the overall (combined) effect estimate was presented in the form of an odds ratio (summary statistic).

Results: Of 426 patients (from 27 articles), 256 (60.1%) underwent preoperative TIPS. Random effects MA showed significantly lower odds of postoperative ascites with preoperative TIPS (OR = 0.40, 95% CI 0.22-0.72; I2 = 0%). There were no significant differences in 90-day mortality (3 studies: OR = 0.76, 95% CI 0.33-1.77; I2 = 18.2%), perioperative transfusion requirement (3 studies: OR = 0.89, 95% CI 0.28-2,84; I2 = 70.1%), postoperative hepatic encephalopathy (2 studies: OR = 0.97, 95% CI 0.35-2.69; I2 = 0%), and postoperative ACLF (3 studies: OR = 1.02, 95% CI 0.15-6.8, I2 = 78.9%).

Conclusions: Preoperative TIPS appears safe in cirrhotic patients who undergo elective and emergency surgery and may have a potential role in postoperative ascites control. Future randomized clinical trials should test these preliminary results.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

World Journal of Emergency Surgery EMERGENCY MEDICINE-SURGERY

CiteScore

14.50

自引率

5.00%

发文量

审稿时长

10 weeks

期刊介绍： The World Journal of Emergency Surgery is an open access, peer-reviewed journal covering all facets of clinical and basic research in traumatic and non-traumatic emergency surgery and related fields. Topics include emergency surgery, acute care surgery, trauma surgery, intensive care, trauma management, and resuscitation, among others.