Factors Associated With Acute Kidney Injury After Cardiopulmonary Bypass in Children.

Background: Acute kidney injury (AKI) is a common complication after cardiovascular surgery in children, noted in approximately 40% of children undergoing cardiopulmonary bypass (CPB). We sought to determine the risk factors including inflammatory and vascular endothelial markers associated with AKI in children undergoing cardiac surgery. Methods: A secondary analysis of a prospective observational cohort study of paediatric patients with a cardiac defect requiring CPB and a weight of >2.5 kg was performed. AKI was defined as a 1.5 times increase from the preoperative value in serum creatinine or an absolute increase by ≥0.3 mg/dL (≥26.5 µmol/L). Plasma inflammatory markers (interleukin [IL]-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, and tumour necrosis factor α) and vascular endothelial markers (vascular endothelial growth factor, von Willebrand factor, regulated on activation, normal T-cell expressed and secreted, granulocyte macrophage colony-stimulating factor, monocyte chemoattractant protein-1, platelet-derived growth factor, and microparticles) were assessed at 5 perioperative time points. Associations with AKI were found using generalized linear regression models adjusted for repeated measures. Results: A total of 207 patients were assessed, of whom 56% (n = 116) were male. Thirty-three percent (n = 68) developed AKI. In univariable analyses, adverse outcomes significantly related to the presence of AKI included increased intensive care unit stay (3.0 vs 5.6 hours, P < 0.001). In multivariable analysis, independent factors that were significantly associated with AKI included longer duration of CPB (111 vs 154 minutes, P < 0.001) and lower preoperative creatinine. Inflammatory and vascular endothelial biomarkers were not associated with AKI. Conclusions: AKI remains a prevalent problem after cardiac surgery, and renal ischemia related to longer bypass time potentially plays a key role in the etiology. Inflammatory and vascular endothelial biomarkers were not significantly related to AKI.

Contexte: L'insuffisance rénale aiguë (IRA) est une complication fréquente qui survient chez les enfants après une intervention chirurgicale cardiovasculaire. Environ 40 % des enfants chez qui une circulation extracorporelle (CEC) est mise en place durant l'intervention présentent ultérieurement une IRA. Nous avons tenté de définir les facteurs de risque, y compris les marqueurs inflammatoires et endothéliaux vasculaires, qui sont associés à l'IRA chez les enfants qui subissent une intervention chirurgicale cardiaque. Méthodologie: Nous avons réalisé une analyse secondaire d'une étude de cohorte observationnelle prospective menée auprès d'enfants qui étaient atteints d'une anomalie cardiaque nécessitant une CEC et qui pesaient plus de 2,5 kg. L'IRA était définie comme une hausse du taux de créatinine sérique par un facteur de 1,5 par rapport à la valeur préopératoire ou comme une augmentation absolue de ≥ 0,3 mg/dL (≥ 26,5 µmol/l). Les marqueurs inflammatoires plasmatiques (interleukine [IL]-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, facteur de nécrose tumorale alpha) et les marqueurs endothéliaux vasculaires (facteur de croissance de l'endothélium vasculaire, facteur de von Willebrand, chimiokine exprimée et sécrétée après l'activation des lymphocytes T normaux, facteur de stimulation des granulocytes et macrophages, protéine chimiotactique des monocytes-1, facteur de croissance dérivé des plaquettes, microparticules) ont été évalués à 5 moments périopératoires différents. Les associations avec l'IRA ont été établies au moyen de modèles de régression linéaire généraux, qui ont été ajustés pour tenir compte des mesures répétées. Résultats: L'évaluation a porté sur 207 patients, dont 56 % (n = 116) étaient des garçons, et une IRA a été observée chez 33 % (n = 68) d'entre eux. Les résultats d'analyses univariées ont montré que les issues indésirables associées de façon significative à la présence d'une IRA comprenaient un séjour prolongé à l'unité de soins intensifs (3,0 c. 5,6 heures, p < 0,001). Dans les analyses multivariées, les facteurs indépendants associés de façon significative à une IRA comprenaient une CEC prolongée (111 c. 154 minutes, p < 0,001) et un faible taux de créatinine préopératoire. Les biomarqueurs inflammatoires et endothéliaux vasculaires n'ont pas été associés à l'IRA. Conclusions: L'IRA demeure un problème répandu après une intervention chirurgicale cardiaque. L'ischémie rénale associée à une CEC prolongée joue potentiellement un rôle clé dans son étiologie. Par ailleurs, les biomarqueurs inflammatoires et endothéliaux vasculaires n'ont pas été associés de façon significative à l'IRA.

Comparing surgical outcomes of anterior capsular release vs circumferential release for persistent capsular stiffness.

Purpose: To consolidate the existing literature evaluating anterior capsular release and circumferential capsular release in the treatment of adhesive capsulitis (AC) of the shoulder. Methods: The electronic databases PUBMED, EMBASE, MEDLINE and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 8, 2020. Data are presented descriptively where appropriate. A meta-analysis was conducted for patient-reported outcomes. Results: Overall, there were forty-six articles included. The majority of patients underwent circumferential release compared to anterior release (80.1% vs. 19.9%). Concomitant Manipulation Under Anesthesia (MUA) was employed in 25 studies, with a higher occurrence in the anterior compared to the circumferential release group (70% vs 60%). Both groups experienced significant improvements postoperatively in range of motion (ROM) and patient-reported outcomes. Complication rates were low for both anterior release (0.67%) and 360° release (0.44%). Conclusion: Both anterior and circumferential release are effective techniques for treating AC with low complication rates. Future studies should improve documentation of patient demographics, surgical techniques and outcomes to determine an individualized treatment protocol for patients. Level of evidence: Level IV, Systematic Review of Level I-IV studies.

Reduction of opioid use after orthopedic surgery: a scoping review.

BACKGROUND: The opioid epidemic is one of the biggest public health crises of our time, and overprescribing of opioids after surgery has the potential to lead to long-term use. The purpose of this review was to identify and summarize the available evidence on interventions aimed at reducing opioid use after orthopedic surgery. METHODS: We searched CENTRAL, Embase and Medline from inception until August 2019 for studies comparing interventions aimed at reducing opioid use after orthopedic surgery to a control group. We recorded demographic data and data on intervention success, and recorded or calculated percent opioid reduction compared to control. RESULTS: We included 141 studies (20 963 patients) in the review, of which 113 (80.1%) were randomized controlled trials (RCTs), 6 (4.3%) were prospective cohort studies, 16 (11.4%) were retrospective cohort studies, 5 (3.6%) were case reports, and 1 (0.7%) was a case series. The majority of studies (95 [67.4%]) had a follow-up duration of 2 days or less. Interventions included the use of local anesthetics and/or nerve blocks (42 studies [29.8%]), nonsteroidal anti-inflammatory drugs (31 [22.0%]), neuropathic pain medications (9 [6.4%]) and multimodal analgesic combinations (25 [17.7%]. In 127 studies (90.1%), a significant decrease in postoperative opioid consumption compared to the control intervention was reported; the median opioid reduction in these studies was 39.7% (range 5%-100%). Despite these reductions in opioid use, the effect on pain scores and on incidence of adverse effects was inconsistent. CONCLUSION: There is a large body of evidence from randomized trials showing the promise of a variety of interventions for reducing opioid use after orthopedic surgery. Rigorously designed RCTs are needed to determine the ideal interventions or combination of interventions for reducing opioid use, for the good of patients, medicine and society.

Revision Arthroscopic Bankart Repair for Anterior Shoulder Instability After a Failed Arthroscopic Soft-Tissue Repair Yields Comparable Failure Rates to Primary Bankart Repair: A Systematic Review.

BACKGROUND: The management of recurrent instability after arthroscopic Bankart repair remains challenging. Of the various treatment options, arthroscopic revision repairs are of increasing interest due to improved visualization of pathology and advancements in arthroscopic techniques and instrumentation. PURPOSE: We sought to assess the indications, techniques, outcomes, and complications for patients undergoing revision arthroscopic Bankart repair after a failed index arthroscopic soft-tissue stabilization for anterior shoulder instability. METHODS: We performed a systematic review of studies identified by a search of Medline, Embase, and PubMed. Our search range was from data inception to April 29, 2020. Outcomes include clinical outcomes and rates of complication and revision. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. RESULTS: Twelve studies were identified, comprising 279 patients (281 shoulders) with a mean age of 26.1 ± 3.8 years and a mean follow-up of 55.7 ± 24.3 months. Patients had improvements in postoperative outcomes (eg, pain and function). The overall complication rate was 29.5%, the most common being recurrent instability (19.9%). CONCLUSION: With significant improvements postoperatively and comparable recurrent instability rates, there exists a potential role in the use of revision arthroscopic Bankart repair where the glenoid bone loss is less than 20%. Clinicians should consider patient history and imaging findings to determine whether a more rigorous stabilization procedure is warranted. Large prospective cohorts with long-term follow-up and improved documentation are required to determine more accurate failure rates.

Update on all-arthroscopic vs. mini-open rotator cuff repair: A systematic review and meta-analysis.

PURPOSE: To provide an updated comparison between modern arthroscopic and mini-open repairs for treating rotator cuff tears. METHODS: Multiple online databases were searched from 2010 to October 1st, 2020. A meta-analysis was conducted for patient-reported outcomes and complications. RESULTS: Eleven studies were included. Majority of patients underwent mini-open repair (MOR) compared to arthroscopic repair (AR) (57.4% vs 42.6%). A meta-analysis found statistically significant differences (p < 0.05) in patient-reported outcomes favouring AR. While retear rates were higher in AR (p = 0.03) analysis of retear rates for arthroscopic double row and mini-open repairs, yielded no differences between groups (p = 0.48). CONCLUSION: Patients undergoing AR for rotator cuff tears had improved post-operative clinical outcomes in some functional outcomes compared to MOR. Modern arthroscopic double row repair result in similar failure rates to open repair techniques. LEVEL OF EVIDENCE: Level III, Systematic Review of Level I-III studies.

Energy Drinks and Their Adverse Health Effects: A Systematic Review and Meta-analysis.

CONTEXT: Energy drinks are the fastest growing product in the beverage industry. However, there is concern regarding potential for adverse effects with use. OBJECTIVE: To evaluate the reported adverse effects of energy drink consumption. DATA SOURCES: The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from inception to November 2019, and pertinent data were abstracted. STUDY SELECTION: Only clinical studies reporting adverse events after energy drink consumption were included. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data regarding sample size characteristics, energy drink characteristics, comparators, and all adverse events were extracted in duplicate and recorded. RESULTS: A total of 32 studies and 96,549 individuals were included. Frequently reported adverse events in the pediatric population were insomnia (35.4%), stress (35.4%), and depressive mood (23.1%). Frequently reported adverse events in the adult population were insomnia (24.7%), jitteriness/restlessness/shaking hands (29.8%), and gastrointestinal upset (21.6%). Alcohol mixed with energy drinks significantly reduced the likelihood of sedation effects but increased the likelihood of stimulatory effects. Energy drink consumption significantly increased the odds of insomnia (OR, 5.02; 95% CI, 1.72-14.63) and jitteriness/activeness (OR, 3.52; 95% CI, 1.28-9.67) compared with the control group. CONCLUSION: The authors recommend that individuals avoid frequent energy drink consumption (5-7 energy drinks/week) and avoid co-consumption with alcohol; increased regulatory standards should be placed in the sale of energy drinks, particularly with regard to the pediatric population.