Evidence map›Paper›PMID 34507273›Full record

ArticleJMIR research protocols2021

Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-analysis.

Derek J Roberts, Hannah Dreksler, Sudhir K Nagpal, Allen Li, Jeanna Parsons Leigh, Timothy Brandys, Prasad Jetty, Luc Dubois, Henry T Stelfox, Daniel I McIsaac

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JMIR research protocols, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.4field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 3 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Derek J RobertsDivision of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.ORCID https://orcid.org/0000-0001-6111-6291
Hannah DrekslerDivision of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.ORCID https://orcid.org/0000-0003-3879-1728
Sudhir K NagpalDivision of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.ORCID https://orcid.org/0000-0002-4584-8975
Allen LiDivision of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.ORCID https://orcid.org/0000-0001-6615-7295
Jeanna Parsons LeighSchool of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada.ORCID https://orcid.org/0000-0002-8408-674X
Timothy BrandysDivision of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.ORCID https://orcid.org/0000-0002-4569-7636
Prasad JettyDivision of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.ORCID https://orcid.org/0000-0003-0538-4456
Luc DuboisDivision of Vascular Surgery, Department of Surgery, Western University, London, ON, Canada.ORCID https://orcid.org/0000-0002-8828-6896
Henry T StelfoxDepartment of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.ORCID https://orcid.org/0000-0003-1231-1490
Daniel I McIsaacClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, Canada.ORCID https://orcid.org/0000-0002-8543-1859
University of Ottawa · CADalhousie University · CAUniversity of Calgary · CAWestern University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients undergoing lower limb revascularization surgery for peripheral artery disease (PAD) have a high risk of perioperative morbidity and mortality and often have long hospital stays. Use of neuraxial or regional anesthesia instead of general anesthesia may represent one approach to improving outcomes and reducing resource use among these patients.

objectiveThe aim is to conduct a systematic review and meta-analysis to determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes and costs and a shorter length of hospitalization.

methodsWe will search electronic bibliographic databases (MEDLINE, EMBASE, the seven databases in Evidence-Based Medicine Reviews, medRxiv, bioRxiv, and Google Scholar), review papers identified during the search, and included article bibliographies. We will include randomized and nonrandomized studies comparing the use of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD. Two investigators will independently evaluate the risk of bias. The primary outcome will be short-term (in-hospital or 30-day) mortality. Secondary outcomes will include longer-term mortality; major adverse cardiovascular, pulmonary, renal, and limb events; delirium; deep vein thrombosis or pulmonary embolism; neuraxial or regional anesthesia-related complications; graft-related outcomes; length of operation and hospital stay; costs; and patient-reported or functional outcomes. We will calculate summary odds ratios (ORs) and standardized mean differences (SMDs) using random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. We will assess for publication bias using the Begg and Egger tests and use the trim-and-fill method to estimate the potential influence of this bias on summary estimates. Finally, we will use Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to make an overall rating of the quality of evidence in our effect estimates.

resultsThe protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We executed the peer-reviewed search strategy on March 2, 2021. We completed the review of titles and abstracts on July 30, 2021, and plan to complete the review of full-text papers by September 30, 2021. We will complete full-text study data extraction and the risk-of-bias assessment by November 15, 2021, and conduct qualitative and then quantitative data synthesis and GRADE assessment of results by January 1, 2022, before drafting the manuscript. We anticipate that we will be able to submit the manuscript for peer review by the end of February 2022.

conclusionsThis study will synthesize existing evidence regarding whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes, graft patency, and costs and a shorter length of hospital stay. Study results will be used to inform practice and future research, including creation of a pilot and then multicenter randomized controlled trial.

trial registrationProspero CRD42021237060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=237060. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/32170.

Indexed as

anesthesiaarterycardiovascularepidural anesthesiahospitallimblower limb revascularization surgerynervesneuraxial anesthesiaoutcomeperipheral artery diseaseprotocolreviewspinal anesthesiaspinesurgeryvascular surgery

Identifiers

PMID34507273
PMCPMC8665382
OpenAlexW3191977335

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.