Identifying surgical patients with obstructive sleep apnoea may assist with anaesthetic management to minimise postoperative complications. Using trial sequential analysis, we evaluated the impact of obstructive sleep apnoea diagnosed by polysomnography or home sleep apnoea testing on postoperative outcomes in surgical patients. Multiple databases were systematically searched. Outcomes included: total postoperative complications, systemic complications (cardiovascular, respiratory, neurological, renal, infectious) and specific complications (atrial fibrillation, myocardial infarction, combined hospital and intensive care unit re-admission, mortality). The pooled odds ratios of postoperative complications were evaluated by the Mantel-Haenszel method random-effects model. Meta-analysis and meta-regression were conducted, and the GRADE approach was used to evaluate the certainty of evidence. Twenty prospective cohort studies with 3756 patients (2127 obstructive sleep apnoea and 1629 non-obstructive sleep apnoea) were included (9 in non-cardiac surgery and 11 in cardiac surgery). Postoperative complications were almost two-fold higher with obstructive sleep apnoea, OR (95%CI) 1.92 (1.52-2.42), p < 0.001; certainty of evidence, moderate. Obstructive sleep apnoea was associated with a 1.5 times increased risk of postoperative cardiovascular complications, OR (95%CI) 1.56 (1.20-2.02), p = 0.001; certainty of evidence, moderate; an almost two-fold increase in respiratory complications, OR (95%CI) 1.91 (1.39-2.62), p < 0.001; certainty of evidence, moderate; and hospital and ICU re-admission, OR (95%CI) 2. 25 (1.21-4.19), p = 0.01; certainty of evidence, low. Trial sequential analysis showed adequate information size for postoperative complications. Baseline confounding factors were adjusted by meta-regression, and the sub-group analysis did not materially change our results. This increased risk occurred especially in patients in whom obstructive sleep apnoea had been newly diagnosed, emphasising the importance of pre-operative screening.

Purpose Worldwide, spinal cord injuries are associated with diminished participation in the labor market. Inconclusive reporting and differences between workplace settings for individuals with spinal cord injury (SCI) make conceptualizing return to work rates among this population inherently challenging. The objectives of this study are to explore factors associated with return to work (RTW) following an SCI. Moreover, the factors were classified according to the work disability prevention framework. Finally, we conducted a meta-analysis of the prevalence of RTW following an SCI. Methods Original articles were identified through a literature search in four health databases. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the mapping and identification of records. Included studies contained primary studies that included the nature of the injury, antecedent factors associated with the injury, and study characteristics and RTW outcomes. Exclusion criteria for the studies included if there was no discussion of RTW outcomes, systematic reviews, and meta-analyses. Results A total of 461 full-text articles were assessed for eligibility, and eight studies were included and assessed using the Critical Appraisal Skills Programme checklist, Risk of Bias, and Newcastle–Ottawa Scale. Four studies identified personal system factors, four identified healthcare system factors, two identified compensation system factors, and one identified workplace system factors. Conclusions Attempts to optimize RTW among persons with SCI are inherently difficult due to the diversity of this client population. Findings from the studies included in this systematic review support the utility of interventions for facilitating RTW, such as vocational rehabilitation and workplace accommodations, while simultaneously acknowledging the limitations in identifying specific interventions as facilitatory or inhibitory throughout the process.

Background: Ocular injuries are an important workplace hazard that can lead to vision loss, decreased functioning, and socioeconomic costs. The aim of this systematic review is to identify types of occupational ocular injuries and examine factors associated with these injuries.Methods: Four health sciences databases (Ovid Medline, Embase, PsycINFO, and CINAHL) were reviewed to identify evidence pertaining to occupational ocular injuries. This systematic review was registered with PROSPERO (registration number: CRD42018089876) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PICO (Population/Intervention/ Comparison/Outcome) tool was used to support, structure, and improve our search strategy. Results: Overall, 12 studies with quantitative Critical Appraisal Skills Programme grading scores were assessed in a systematic review and meta-analysis of ocular injuries in the workplace. The systematic review identified four main factors associated with occupational ocular injury: (a) use of eye protection at the time of the ocular injury, (b) being male, (c) exposure to biological or chemical occupational hazards, and (d) risk-taking behavior.Conclusions: Differences in risk between countries of origin, occupational sectors, and dates of publication, suggest likely differences or changes in safety procedures.We recommend that employers ensure that safety equipment is tailored to the protection of their specific occupational hazards, and that employees are adhering to safety protocols. K E Y W O R D S meta-analysis, occupational health and safety, ocular injuries, ophthalmology, systematic review 3 | RESULTSOverall, 12 studies with quantitative CASP grading scores were assessed to develop a systematic review and meta-analysis of ocular injuries in the workplace. The characteristics of the study, including the antecedent factors and causes of injury and respective CASP scores, are described in Table 2. The 12 studies reported mean CASP grades within the range of 6.50 to 10.0 with a mean score of 7.87 (SD = 1.17). The studies covered the geographic regions of 590 |