Efficacy and safety of robotic spine surgery: systematic review and meta-analysis.

BACKGROUND: Robotic surgery (RS) may offer benefits compared with freehand/conventional surgery (FS) in the treatment of patients with spinal disease. The aim of this study was to evaluate the efficacy and safety of RS versus FS in spinal fusion. METHODS: A systematic review and meta-analysis was performed. Data analysis and risk of bias assessment were analysed using REVMAN V5.3. RESULTS: We found 11 randomised clinical trials involving 817 patients (FS: 408, RS: 409). The main diagnosis was degenerative spine disease. SpineAssist, Renaissance (Mazor Robotics), Tianji Robot and TiRobot robots (TINAVI Medical Technologies) were used. Pedicle screw placement within the safety zone (grades A + B according to the Gertzbein and Robbins scale) ranged from 93% to 100% in FS versus 85-100% in RS (relative risk 1.01, 95% CI 1.00-1.03, p = 0.14). Regarding intervention time, the meta-analysis showed a mean difference (MD) of 6.45 min (95% CI -13.59 to 26.49, p = 0.53). Mean hospital stay was MD of -0.36 days (95% CI -1.03 to 0.31, p = 0.30) with no differences between groups. Contradictory results were found regarding fluoroscopy time, although there seems to be a lower radiation dose in RS versus FS (p < 0.05). Regarding safety, the studies included surgical revision frequency. CONCLUSIONS: No conclusive results were found suggesting that there are benefits in using RS over FS for spinal fusion. Further research with adequate patient selection, robot type and quality-of-life variables is needed. LEVEL OF EVIDENCE: level 1.

Lamivudine and Entecavir for Acute Hepatitis B: A Systematic Review and Meta-Analysis.

BACKGROUND: Acute hepatitis B infection is associated with severe liver disease and chronic sequelae in some cases. The purpose of this review was to determine the efficacy of nucleoside analogues (NA) (lamivudine versus entecavir) compared to placebo or no intervention for treating acute primary HBV infection. METHODS: A meta-analysis for drug intervention was performed, following a fixed-effect model. Randomized controlled trials (RCTs) and quasi-randomized studies that evaluated the outcomes of NA in acute hepatitis B infection were included. The following outcomes were considered: virological cure (PCR negative), elimination of acute infection (seroconversion of HBsAg), mortality, and serious adverse events. RESULTS: Five trials with 627 adult participants with severe acute hepatitis B defined by biochemical and serologic parameters were included. Virological cure did not favor any intervention: OR 0.96, 95% CI 0.54 to 1.7 (p = 0.90), I2 = 58%. Seroconversion of HBsAg to negative favored placebo/standard-of-care compared to lamivudine: OR 0.54, 95% CI 0.33 to 0.9 (p = 0.02), I2 = 31%. The only trial that compared entecavir and lamivudine favored entecavir over lamivudine (OR: 3.64, 95% CI 1.31-10.13; 90 participants). Adverse events were mild. CONCLUSION: There is insufficient evidence that NA obtain superior efficacy compared with placebo/standard-of-care in patients with acute viral hepatitis, based on low quality evidence.

Effect of the Implementation of a Surgical Care Bundle in the Incidence of Surgical Site Infection in Spine Surgery: A Quasi-Experimental Study.

STUDY DESIGN: Quasi-experimental intervention study. OBJECTIVE: To assess the effect of a clinical safety and quality improvement plan for patients undergoing spinal fusion surgery on the incidence of surgical site infection (SSI). SUMMARY OF BACKGROUND DATA: In recent years, infection surveillance and control programs based on care bundles have been included in surgical protocols. These have proven to be essential tools for the prevention and control of SSI, providing indicators for improvement and allowing the characterization of related risk factors. METHODS: A quasi-experimental study was carried out with analysis before and after the introduction of a preventive care bundle (clinical safety and quality improvement plan). Patients who underwent spinal fusion surgery were included. The incidence of SSI up to 90 days after surgery (maximum incubation period) was assessed. The effect of the intervention was evaluated with the adjusted odds ratio (oR) using a logistic regression model. RESULTS: A total of 1554 patients were included, 690 in the period 2007 to 2011 (before) and 864 during 2012 to 2018 (after). SSI incidence decreased from 4.2% to 1.9% after the plan (OR: 0.43; 95% confidence interval: 0.23-0.80; P  = 0.006). There was also an improvement in the adequacy of antibiotic prophylaxis, preoperative preparation, and hair removal procedure after the introduction of the care bundle. CONCLUSION: After implementation of the care bundle, the incidence of SSI in spine fusion surgery decreased significantly. Multivariate analysis showed that the care bundle was an independent protective factor. The implementation of these measures should be reinforced on the routine medical practice to reduce the SSI incidence.Level of Evidence: 3.

Surgical site infection in hip arthroplasty in a 10-year follow-up prospective study: Risk and factors associated.

BACKGROUND: The increased demand for hip arthroplasty means a growing number of postsurgical complications. This study aims to assess the risk of surgical site infection (SSI) in a teaching hospital; develop regional, national and international external comparisons; and evaluate SSI-related risk factors, particularly according to the timing of surgery (urgent/unplanned or elective). METHODS: Prospective cohort study from January 2008 to December 2018. Patients were followed up to 90 days after surgery. Primary endpoint was SSI incidence according to the Centers for Disease Control and Prevention criteria. Multivariate analysis was conducted to find independently associated SSI risk factors. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR). Analyses were also performed among urgent/unplanned and elective patients to identify whether SSI risk factors differed between groups. RESULTS: The study population (n = 1,808) has an overall SSI rate of 3.0% (95% confidence interval [CI]: 2.4-3.9). Timing of surgery caused an effect modification, so surgery duration> 75th percentile (OR: 3.8; 95% CI: 1.5-9.8) and inadequate preparation (OR: 3.3; 95% CI: 1.1-10.0) were independent risk factors in the urgent/unplanned group; National Healthcare Safety Network risk index≥ 2 (OR: 6.3; 95% CI: 0.1-19.2) and transfusion (OR: 3.6; 95% CI: 1.1-11.9) in the elective group. CONCLUSIONS: Hospital infection surveillance systems allow identifying risk factors susceptible to change. Characterization of factors that caused an effect modification is key to identify areas of quality improvement, including reducing operating times, preventing perioperative blood transfusion, or improving patient preparation before surgery.

[Antibiotic prophylaxis in prostatic surgery: Adherence to the hospital protocol. Prospective cohort study.] / Profilaxis antibiótica en cirugía de próstata: adecuación al protocolo hospitalario. Estudio de cohortes prospectivo.

OBJECTIVES: To assess the adherence to the antibiotic prophylaxis protocol in patients undergoing prostate surgery and evaluate the effect of antibiotic prophylaxis on surgical site infections (SSI). MATERIAL AND METHODS: A prospective cohort study was carried out between January 2009 and September 2016. The global compliance with the antibiotic prophylaxis protocol was evaluated studying the items: time of onset, route of administration, antibiotic prescribed, duration and dose. Percentages of adequacy are described. The incidence of infection was calculated after 30 days of follow-up. Relationship between the adequacy to the protocol and the surgical site infection are described with the relative risk. RESULTS: A total of 595 patients were studied. The global adequacy was 93.8%. The leading cause of inadequacy was the time of onset 3%. The incidence of surgical site infection was 1%. No relationship between the inadequacy of antibiotic prophylaxis and surgical site infection (RR=1.1%; 95%CI: 1.0-1.2) was found. No relationship between the procedure (laparoscopic or open surgery) and surgical site infection (RR=0.4%; 95%CI: 0.1-1.9) was found. CONCLUSIONS: The adequacy of antibiotic prophylaxis was high. The incidence of surgical site infection was low and compliance of antibiotic prophylaxis contributes to diminish surgical site infection incidence.

OBJETIVO: El objetivo de este trabajo ha sido evaluar la adecuación de la profilaxis antibiótica y su relación con la incidencia de infección de sitio quirúrgico (ISQ) en pacientes sometidos a cirugía de próstata.MATERIAL Y MÉTODOS: Estudio de cohortes prospectivo, realizado de enero de 2009 a septiembre de 2016. Se evaluó la adecuación global al protocolo de profilaxis antibiótica y de cada apartado de la profilaxis (inicio, vía de administración, antibiótico de elección, duración y dosis). Se describieron los porcentajes de adecuación. Se calculó la incidencia de infección tras un periodo máximo de 30 días de incubación. Se evaluó la adecuación entre adecuación de la profilaxis e ISQ mediante el riesgo relativo (RR). RESULTADOS: Se incluyeron 595 pacientes en el estudio. La adecuación global fue del 93,8%. La mayor causa de incumplimiento fue el inicio de la profilaxis con un 3,0%. La incidencia de infección de sitio quirúrgico fue del 1,0%. No se encontró relación entre la inadecuación de la profilaxis antibiótica y la infección de sitio quirúrgico (RR=1,01; IC95%: 1,00-1,02). No se encontró relación en el riesgo de infección entre la cirugía laparoscópica y la cirugía abierta (RR=0,37; IC95%: 0,08-1,98). CONCLUSIONES: La adecuación de la profilaxis antibiótica fue alta. La incidencia de infección de sitio quirúrgico fue baja y la adecuada cumplimentación de la profilaxis antibiótica en la cirugía de próstata permite reducir la incidencia de infección de sitio quirúrgico.

Surgical site infection incidence and risk factors in knee arthroplasty: A 9-year prospective cohort study at a university teaching hospital in Spain.

BACKGROUND: Surgical site infection (SSI) is one of the complications posed by knee replacement surgery. Hospital-based infection surveillance systems may provide indicators of improvement and allow the characterization of risk factors critical to reduce infection. The aims of this study were to compare the incidence of SSI in our center with rates in the Madrid Region, Spain, and the United States, and to evaluate any possible SSI-related risk factor in knee replacement surgery. METHODS: All patients who underwent knee replacement surgery at a tertiary hospital in 2008-2016 were included. SSI was defined according to Centers for Disease Control and Prevention criteria. Infection rate was calculated. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR) with multivariate analysis. RESULTS: The study population (n = 1969) had a global SSI risk of 1.0%. We found a declining trend in the follow-up period, from an SSI risk of 1.8% in 2009 to 0.4% in 2016. Independent risk factors included hair removal (OR: 3.09, 95% confidence interval [CI]: 1.27-7.50) and National Healthcare Safety Network risk index ≥ 2 (OR: 9.37, 95% CI: 2.90-30.26). CONCLUSION: This study identified risk factors that showed the necessity to strictly comply with wound decontamination and patient preparation protocols, reduce surgery duration, and identify patients who require comprehensive monitoring.

A systematic review of the use of health services by immigrants and native populations.

BACKGROUND: Changes in migration patterns that have occurred in recent decades, both quantitative, with an increase in the number of immigrants, and qualitative, due to different causes of migration (work, family reunification, asylum seekers and refugees) require constant u pdating of the analysis of how immigrants access health services. Understanding of the existence of changes in use patterns is necessary to adapt health services to the new socio-demographic reality. The aim of this study is to describe the scientific evidence that assess the differences in the use of health services between immigrant and native populations. METHODS: A systematic review of the electronic database MEDLINE (PubMed) was conducted with a search of studies published between June 2013 and February 2016 that addressed the use of health services and compared immigrants with native populations. MeSH terms and key words comprised Health Services Needs and Demands/Accessibility/Disparities/Emigrants and Immigrants/Native/Ethnic Groups. The electronic search was supplemented by a manual search of grey literature. The following information was extracted from each publication: context of the study (place and year), characteristics of the included population (definition of immigrants and their sub-groups), methodological domains (design of the study, source of information, statistical analysis, variables of health care use assessed, measures of need, socio-economic indicators) and main results. RESULTS: Thirty-six publications were included, 28 from Europe and 8 from other countries. Twenty-four papers analysed the use of primary care, 17 the use of specialist services (including hospitalizations or emergency care), 18 considered several levels of care and 11 assessed mental health services. The characteristics of immigrants included country of origin, legal status, reasons for migration, length of stay, different generations and socio-demographic variables and need. In general, use of health services by the immigrants was less than or equal to the native population, although some differences between immigrants were also identified. CONCLUSIONS: This review has identified that immigrants show a general tendency towards a lower use of health services than native populations and that there are significant differences within immigrant sub-groups in terms of their patterns of utilization. Further studies should include information categorizing and evaluating the diversity within the immigrant population.