Hip dysplasia is a condition affecting both infants and adults, characterized by a shallow acetabulum that does not sufficiently cover the head of the femur. This leads to instability of the hip and elevated levels of mechanical stress around the acetabular rim. A popular procedure for the correction of hip dysplasia is the periacetabular osteotomy (PAO), in which fluoroscopically guided osteotomies around the pelvis are made to allow for repositioning of the acetabulum to fit properly on the femoral head. This systematic review aims to analyze patient factors that impact outcomes, as well as patient-reported outcomes such as the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The patients in this review did not undergo any prior intervention for acetabular hip dysplasia, allowing for an unbiased reporting of outcomes from all included studies. Of studies reporting HHS, the mean preoperative HHS was 68.92 and the mean postoperative HHS was 89.1. Of the study that reported mHHS, the mean preoperative mHHS was 70, and the mean postoperative mHHS was 91. Of the studies reporting WOMAC, the mean preoperative WOMAC was 66, and the mean postoperative WOMAC was 63. Key findings of this review are that of the seven included studies, six achieved a minimally important clinical difference (MCID) based on patient-reported outcomes, and factors impacting outcome are preoperative Tönnis osteoarthritis (OA) grade, pre and postoperative lateral-center edge angle (LCEA), preoperative hip joint congruency, postoperative Tönnis angle, and age. In patients with no prior intervention for hip dysplasia, the PAO is a successful procedure with significant improvement in postoperative patient-reported outcomes. Despite the reported success of the PAO, proper patient selection is vital to avoid early conversions to total hip arthroplasty (THA) and prolonged pain. However, further investigation is prompted regarding the long-term survivorship of the PAO in patients with no prior intervention for hip dysplasia.
BACKGROUND As of 2022, patient postoperative non-compliance can increase the risk of complications by up to 52.4% after laparoscopic abdominal surgery, however, no singular pre-operative education intervention (POEI) demonstrates consistent improvement in patient outcomes across the procedures. OBJECTIVE This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEI reported in the literature. METHODS 4,753 articles investigating POEI (e.g. videos, presentations, mobile applications, one-on-one education or coaching) were collected from the PubMed, EMBASE, and Scopus databases. Inclusion criteria were: adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and provided postoperative outcomes. Exclusion criteria included: not published in English and no outcomes reported. Title/abstract and full-text articles with POEI randomized controlled studies were screened based on the criteria through a blinded, dual review using Covidence. Study quality was assessed through the Cochrane Risk of Bias tool. Included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery. This study protocol has been registered to PROSPERO: CRD42023438698. RESULTS Only 17 studies matched our criteria, with 1,831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. 15 studies reported a statistically significant improvement in at least one patient postoperative outcome. None of these studies had an overall Cochrane high risk of bias. 41.2% of the included studies used one-on-one education or coaching improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (p<0.01). Group education or coaching demonstrates significant improvement in weight, BMI, exercise, and depressive symptoms in 33.3% of the laparoscopic gastric bypass studies. CONCLUSIONS Direct education or coaching (one-on-one or group-based) positively impacts postoperative outcomes more than the newer POEIs (e.g. mobile applications). CLINICALTRIAL This study protocol has been registered to PROSPERO: CRD42023438698.
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