The possible effect of different types of ventilation on reducing operation theatre infections: a meta-analysis.

INTRODUCTION: The relation between type of ventilation used in the operating theatre and surgical site infection has drawn considerable attention. It has been reported that there is a possible relationship between the type of ventilation used in the operation theatre and surgical site infection. This meta-analysis was performed to evaluate this relationship. METHODS: Through a systematic literature search up to May 2020, 14 studies describing 590,121 operations, 328,183 were performed under laminar airflow ventilation and 2,611,938 were performed under conventional ventilation. Studies were identified that reported relationships between type of ventilation with its different categories and surgical site infection (10 studies were related to surgical site infection in total hip replacement, 7 in total knee arthroplasties and 3 in different abdominal and open vascular surgery). Odds ratios with 95% confidence intervals were calculated comparing surgical site infection prevalence and type of theatre ventilation using the dichotomous method with a random or fixed-effect model. FINDINGS: No significant difference was found between surgery performed under laminar airflow ventilation and conventional ventilation in total hip replacement (OR 1.23; 95% CI 0.97-1.56, p = 0.09), total knee arthroplasties (OR 1.14; 95% CI 0.62-2.09, p = 0.67) or different abdominal and open vascular surgery (OR 0.75; 95% CI 0.43-1.33, p = 0.33). The impact of the type of theatre ventilation may have no influence on surgical site infection as a tool for decreasing its occurrence. CONCLUSIONS: Based on this meta-analysis, operating under laminar airflow or conventional ventilation may have no independent relationship with the risk of surgical site infection. This relationship forces us not to recommend the use of laminar airflow ventilation since it has a much higher cost compared with conventional ventilation.

Sarcopenia as a predictor of postoperative risk of complications, mortality and length of stay following gastrointestinal oncological surgery.

INTRODUCTION: Sarcopenia has drawn considerable attention as a predictor of postoperative risk, although the relationship between sarcopenia and postoperative risk is contentious. This meta-analysis was conducted to evaluate this relationship. METHODS: A systematic literature search up to May 2020 was carried out and 43 studies were identified (with 16,716 patients) reporting on the relationship between sarcopenia and postoperative risk. In order to evaluate this relationship, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the dichotomous and continuous method with a random or fixed effects model. RESULTS: Compared with non-sarcopenic patients, those with sarcopenia have a higher major complications rate (OR: 4.03, 95% CI: 2.49-5.57, p<0.001), a higher total complications rate (OR: 1.77, 95% CI: 1.40-2.24, p<0.001), a higher 30-day mortality rate (OR: 2.38, 95% CI: 1.56-3.63, p<0.001) and a longer hospital stay (mean difference: 4.54 days, 95% CI: 2.49-6.59 days, p<0.001). CONCLUSIONS: Sarcopenia significantly increases the risk of major complications, total complications, 30-day mortality and length of hospital stay. For this reason, it is recommended that sarcopenia is added to preoperative risk evaluation to avoid any possible negative outcomes following gastrointestinal oncological surgery.