OBJECTIVE: Risk adjustment following percutaneous coronary intervention (PCI) is vital for clinical quality registries, performance monitoring, and clinical decision-making. There remains significant variation in the accuracy and nature of risk adjustment models utilised in international PCI registries/databases. Therefore, the current systematic review aims to summarise preoperative variables associated with 30-day mortality among patients undergoing PCI, and the other methodologies used in risk adjustments.
METHODS: The MEDLINE, EMBASE, CINAHL, and Web of Science databases until October 2022 without any language restriction were systematically searched to identify preoperative independent variables related to 30-day mortality following PCI. Information was systematically summarised in a descriptive manner following the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. The quality and risk of bias of all included articles were assessed using the Prediction Model Risk Of Bias Assessment Tool. Two independent investigators took part in screening and quality assessment.
RESULTS: The search yielded 2,941 studies, of which 42 articles were included in the final assessment. Logistic regression, Cox-proportional hazard model, and machine learning were utilised by 27 (64.3%), 14 (33.3%), and one (2.4%) article, respectively. A total of 74 independent preoperative variables were identified that were significantly associated with 30-day mortality following PCI. Variables that repeatedly used in various models were, but not limited to, age (n=36, 85.7%), renal disease (n=29, 69.0%), diabetes mellitus (n=17, 40.5%), cardiogenic shock (n=14, 33.3%), gender (n=14, 33.3%), ejection fraction (n=13, 30.9%), acute coronary syndrome (n=12, 28.6%), and heart failure (n=10, 23.8%). Nine (9; 21.4%) studies used missing values imputation, and 15 (35.7%) articles reported the model\'s performance (discrimination) with values ranging from 0.501 (95% confidence interval [CI] 0.472-0.530) to 0.928 (95% CI 0.900-0.956), and four studies (9.5%) validated the model on external/out-of-sample data.
CONCLUSIONS: Risk adjustment models need further improvement in their quality through the inclusion of a parsimonious set of clinically relevant variables, appropriately handling missing values and model validation, and utilising machine learning methods.

BACKGROUND: Recent literature suggests that fixation of trochanteric hip fractures with intramedullary nailing carries a higher 30-day mortality than with sliding hip screw. The present study aims to verify whether this statement is reflected in our practice.
METHODS: Sliding hip screw and intramedullary nail fixation of trochanteric hip fractures were analysed over a 5-year period, between April 2011 and March 2016. Three investigators independently analysed 919 patients. Data collected included 30-day mortality, OTA classification of hip fracture and ASA grading. Inclusion and exclusion criteria were applied.
RESULTS: 493 patients (66%) underwent sliding hip screw while 252 patients (34%) underwent intramedullary femoral nailing. AO/OTA classification was strongly associated with treatment group. It was found that 30-day mortality rate was 4.8% following intramedullary nailing compared to 6.1% with sliding hip screw. Multivariate logistic regression analysis found ASA grade, male gender and age to be associated with increased 30-day mortality with statistical significance. There was no statistically significant association between treatment group and 30-day mortality, nor between ASA grade and treatment group.
CONCLUSIONS: Both the lower 30-day mortality rate of 4.8% with intramedullary nailing and the higher rate of 6.1% with sliding hip screw fixation compare favourably with the mean 7.9% National 30-day mortality rate following hip fractures. The lower 30-day mortality in the intramedullary nailing group was not attributable to lower ASA grading nor due to simpler fracture configuration. ASA grade, male gender and age were shown to be statistically associated with increased 30-day mortality.
CONCLUSIONS: Previous studies may have deterred surgeons from choosing an intramedullary device. However, we hope this study assists surgeons to make an informed decision on the choice of implant particularly when an intramedullary device is required to provide a more stable construct.

UNASSIGNED: The global burden of surgical vascular disease is increasing and with it, the need for cost-effective, accessible prognostic biomarkers to aid optimization of peri-operative outcomes. The neutrophil-lymphocyte ratio (NLR) is emerging as a potential candidate biomarker for perioperative risk stratification. We therefore performed this systematic review and meta-analysis on the prognostic value of elevated preoperative NLR in vascular surgery.
UNASSIGNED: We searched Embase (Ovid), Medline (Ovid), and the Cochrane Library database from inception to June 2019. Screening was performed, and included all peer-reviewed original research studies reporting preoperative NLR in adult emergent and elective vascular surgical patients. Studies were assessed for bias and quality of evidence using a standardized tool. Meta-analysis was performed by general linear (mixed-effects) modelling where possible, and otherwise a narrative review was conducted. Between-study heterogeneity was estimated using the Chi-squared statistic and explored qualitatively.
UNASSIGNED: Fourteen studies involving 5,652 patients were included. The overall methodological quality was good. Elevated preoperative NLR was associated with increased risk of long-term mortality (HR 1.40 [95%CI: 1.13-1.74], Chi-squared 60.3%, 7 studies, 3,637 people) and short-term mortality (OR: 3.08; 95%CI: 1.91-4.95), Chi-squared 66.59%, 4 studies, 945 people). Outcome measures used by fewer studies such as graft patency and amputation free survival were assessed via narrative review.
UNASSIGNED: NLR is a promising, readily obtainable, prognostic biomarker for mortality outcomes following vascular surgery. Heterogeneity in patient factors, severity of vascular disease, and type of vascular surgery performed renders direct comparison of outcomes from the current literature challenging. This systematic review supports further investigation for NLR measurement in pre-vascular surgical risk stratification. In particular, the establishment of a universally accepted NLR cut-off value is of importance in real-world implementation of this biomarker.

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) and radiologically inserted gastrostomy (RIG) have gained increasing popularity among clinicians and motor neuron disease (MND) patients for maintaining adequate nutritional intake. However, there is no consistent evidence of the efficacy and safety of the two techniques in MND patients. We carried out a systematic review and meta-analysis to examine the technical success rates, complication rates and 30-day mortality of MND patients receiving PEG and RIG.
METHODS: We searched PubMed, EMBASE, the Cochrane Library, Web of Science and Scopus from inception to September 12, 2019 for comparative studies on the efficacy and safety of PEG and RIG in MND patients. The primary outcome was technical success rate and the secondary outcomes were complication rates and 30-day mortality.
RESULTS: Seven studies (n = 603) were included. Pooled technical success rates were 90.15% in patients receiving PEG and 96.76% in patients undergoing RIG. There was a statistically significant difference in the technical success rate between RIG and PEG, strongly favoring RIG [(OR = 3.96, 95% CI (1.31to 12.02); P = .02]. Pooled major complication rates were 2.19% in patients receiving PEG and 0.07% in patients undergoing RIG, with no statistical difference (P = .08). Pooled procedure-related 30-day mortality rates were 5.31% in patients receiving PEG and 6.00% in patients undergoing RIG, with no statistically significant difference (P = .75). No publication bias was noted.
CONCLUSIONS: The present meta-analysis demonstrated that, compared to PEG, RIG has a higher technical success rate and has a comparable mortality outcome and safety profile.

BACKGROUND: Saphenous vein grafts (SVG) are a commonly used conduit for coronary artery bypass graft (CABG) surgery and can be harvested by either an open or endoscopic technique. Our goal was to evaluate long-term angiographic and clinical outcomes of open compared to endoscopic SVG harvest for CABG.
METHODS: Electronic search was performed to identify all studies in the English literature that compared open and endoscopic SVG harvesting for CABG with at least one year of follow-up. The primary outcome was graft patency. Secondary outcomes included perioperative morbidity and mortality.
RESULTS: Of 3,255 articles identified, a total of 11 studies were included for analysis. Of 18,131 patients, 10,873 (60%) patients underwent open SVG harvest and 7,258 (40%) patients underwent endoscopic SVG harvest. The mean age of patients was 65 years and 87% were male. The overall mean follow-up period was 2.6 years. During follow-up, patients who underwent open SVG harvest had superior graft patency per graft [open 82.3% vs. endoscopic 75.1%; OR: 0.61 (95% CI, 0.43-0.87); P=0.01], but higher rates of overall wound complications in the immediate post-operative period [open 3.3% vs. endoscopic 1.1%; OR: 0.02 (95% CI, 0.01-0.06); P<0.001]. Patients who underwent open SVG harvest had higher postoperative 30-day mortality [open 3.4% vs. endoscopic 2.1%; OR: 0.59 (95% CI, 0.37-0.94); P=0.03], but no significant difference in overall mortality [open 4.9% vs. endoscopic 4.9%; OR: 0.34 (95% CI, 0.50-1.27); P=0.34].
CONCLUSIONS: Patients who underwent an open SVG harvest technique had improved graft patency and comparable overall mortality to endoscopic SVG harvest at average follow-up time of 2.6 years. Patients with open SVG harvest had higher rates of early wound complications and postoperative 30-day mortality, however, there was no difference in overall mortality.

Hip fracture is a trauma of the elderly. The worldwide number of patients in need of surgery after hip fracture will increase in the coming years. The 30-day mortality ranges between 4 and 14%. Patients\' outcome may be improved by anaesthesia technique (general vs. neuraxial anaesthesia). There is a dearth of evidence from randomised studies regarding to the optimal anaesthesia technique. However, several large non-randomised studies addressing this question have been published from the onset of 2010.
To compare the 30-day mortality rate, in-hospital mortality rate and length of hospital stay after neuraxial (epidural/spinal) or general anaesthesia in hip fracture patients (≥ 18 years old) we prepared a systematic review and meta-analysis. A systematic search for appropriate retrospective observational and prospective randomised studies in Embase and PubMed databases was performed in the time-period from 01.01.2010 to 21.11.2016. Additionally a forward searching in google scholar, a level one reference list searching and a formal searching of trial registries was performed.
Twenty retrospective observational and three prospective randomised controlled studies were included. There was no difference in the 30-day mortality [OR 0.99; 95% CI (0.94 to 1.04), p = 0.60] between the general and the neuraxial anaesthesia group. The in-hospital mortality [OR 0.85; 95% CI (0.76 to 0.95), p = 0.004] and the length of hospital stay were significantly shorter in the neuraxial anaesthesia group [MD -0.26; 95% CI (-0.36 to -0.17); p < 0.00001].
Neuraxial anaesthesia is associated with a reduced in-hospital mortality and length of hospitalisation. However, type of anaesthesia did not influence the 30-day mortality. In future there is a need for large randomised studies to examine the association between the type of anaesthesia, post-operative complications and mortality.