Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

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Presentation transcript:

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Carpal Tunnel Decompression: A Systematic Review and Meta-analysis of Absorbable versus Non-absorbable Sutures for Skin Closure Ryckie G Wade, Justin CR Wormald, Andrea Figus Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Introduction Carpal Tunnel Syndrome is common Annual incidence: 1-2 per 10 (UK) 1 Surgical decompression The definitive treatment 2 The most common surgery on the hand 3 72,000 operations annually Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Carpal Tunnel Decompression Leeds Teaching Hospitals Trust Carpal Tunnel Decompression Absorbable Non-Absorbable Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Absorbable Non-Absorbable Cost of suture = £3.67 Doesn’t require removal = £0 per annum “Risk of infection & scarring” Cost of suture = £2.80 Removal at GP/Hospital = £3 million annually “Better scar” Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Why does this matter? £3 million annually (£41 per Nurse appointment) 5 3750 cataract operations (£800) 1000 total hip replacements (£3k) 300 CABGs (£10k) 100 kidney transplants (£30k) Complications are rare 6 Telephone follow-up Adverse events managed de-novo Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Methods Eligibility = RCTs and quasi-RCTs of adult elective CTD comparing absorbable vs. non-absorbable sutures Exclusion: Children Simultaneous other surgery Revision surgery Outcomes: 1o = pain (VAS) 2o = hand function, scar satisfaction and complications Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Methods: Search Information Scientist Search terms P = carpal tunnel syndrome I = absorbable sutures C = non-absorbable sutures O = pain S = randomised controlled trial Electronic database searches (Jan 1966- May 2015) Cochrane Library, CENTRAL, MEDLINE, EMBASE, USNIH Clinical Trials Registry, ClinicalTrials.gov, WHO Clinical Trials Registry Portal, Reference tracing Here are our search terms according to the PICOS model Relevant databases, grey literature, unpublished works and reference tracking Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Methods: Study Selection Leeds Teaching Hospitals Trust Methods: Study Selection Two independent authors (RGW, JCRW): Title & abstract screening Duplicate removal Full article  In/Out form Discussion PRIMSA flowchart Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Methods: Data Extraction Leeds Teaching Hospitals Trust Methods: Data Extraction Double independent data extraction (RGW, JCRW) Missing data actions (RGW, JCRW) Independent risk of bias assessments (RGW, JCRW, AF) Ris of bias – internal (rigor) and external validity Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Results Article Random-isation Allocation Blinding Data Selective Other Erel (2001) Hansen (2009) Kharwadkar (2005) Menosky (2004) Theopold (2012) Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Results Article Intervention Summary Risk of Bias Erel (2001) 32 absorbable 32 non-absorbable High risk Hansen (2009) 25 absorbable 17 non-absorbable Kharwadkar (2005) 18 absorbable 18 non-absorbable Low risk Menosky (2004) 28 absorbable 26 non-absorbable Theopold (2012) 20 non-absorbable Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Results Postoperative Pain at 10 days Favours Absorbable sutures Favours non-absorbable sutures Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Results Postoperative Pain at 6 weeks Favours Absorbable sutures Favours non-absorbable sutures Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Results Wound inflammation at 10 days Favours Absorbable sutures Favours non-absorbable sutures Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Conclusions Larger, better designed, executed and reported non-inferiority RCTs required Cost utility analysis Use absorbable sutures Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust References Latinovic, R., Gulliford, M. C. & Hughes, R. A. C. Incidence of common compressive neuropathies in primary care. J. Neurol. Neurosurg. Psychiatry 77, 263–5 (2006). Verdugo, R., Salinas, R., Castillo, J. & Cea, J. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst. Rev. (2002). Wildin, C., Dias, J. J., Heras-Palou, C., Bradley, M. J. & Burke, F. D. Trends in elective hand surgery referrals from primary care. Ann R Coll Surg Engl 88, 543–546 (2006). Cochrane handbook for Systematic Reviews of Interventions v5.1.0 (2011) Available at http://handbook.cochrane.org/ Unit Costs of Health and Social Care. PSSRU 2016;171–92. Available from: http://www.pssru.ac.uk/project- pages/unit-costs/2014/ Williams M, Amin A, Getgood A, Hallam P, Chojnowski AJ, Chapman PG. Telephone clinic follow-up following carpal tunnel decompression. J Hand Surg Eur Vol [Internet]. 2008;33(5):641–4. With thanks to Dr Ruth Brassington and co-editors of the NIHR and MRC funded Centre for Neuromuscular Disease), and Professors Richard Wormald and Felix Freshwater for their peer reviews Wade RG, et al. Cochrane Database of Systematic Reviews (2016)

Wade RG, et al. Cochrane Database of Systematic Reviews (2016) Leeds Teaching Hospitals Trust Questions? Wade RG, et al. Cochrane Database of Systematic Reviews (2016)