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Article ; Online: Long-term effects on clinical event, mental health, and related outcomes of CPAP for obstructive sleep apnea: a systematic review.

Balk, Ethan M / Adam, Gaelen P / Cao, Wangnan / Bhuma, Monika Reddy / D'Ambrosio, Carolyn / Trikalinos, Thomas A

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

2024

Abstract: Study objectives: Systematic review of long-term health outcomes of continuous positive airway pressure (CPAP) use in adults with obstructive sleep apnea.: Methods: We updated prior systematic reviews with searches in multiple databases through ... ...

Abstract	Study objectives: Systematic review of long-term health outcomes of continuous positive airway pressure (CPAP) use in adults with obstructive sleep apnea. Methods: We updated prior systematic reviews with searches in multiple databases through January 3, 2023. We included randomized controlled trials (RCTs) and adjusted nonrandomized comparative studies (NRCSs) that reported specified long-term (mostly >1 year) health outcomes. We assessed risk of bias, conducted meta-analyses, and evaluated strength of evidence. Results: We found 38 eligible studies (16 trials, 28 observational). All conclusions were of low strength of evidence given study and data limitations. RCTs found no evidence of effect of CPAP on mortality (summary effect size [ES] 0.89; 95% CI 0.66, 1.21); inclusion of adjusted NRCSs yields an association with reduced risk of death (ES 0.57; 95% CI 0.44, 0.73). RCTs found no evidence of effects of CPAP for cardiovascular death (ES 0.99; 95% CI 0.64, 1.53), stroke (ES 0.99; 95% CI 0.73, 1.35), myocardial infarction (ES 1.05; 95% CI 0.78, 1.41), incident atrial fibrillation (ES 0.89; 95% CI 0.48, 1.63), and composite cardiovascular outcomes (all statistically nonsignificant). RCTs found no evidence of effects for incident diabetes (ES 1.02; 95% CI 0.69, 1.51) and accidents (all nonsignificant), and no clinically significant effects on depressive symptoms, anxiety symptoms, or cognitive function. Conclusions: Whether CPAP use for obstructive sleep apnea affects long-term health outcomes remains largely unanswered. RCTs and NRCSs are inconsistent regarding the effect of CPAP on mortality. Current studies are underpowered, with relatively short duration follow-up and methodological limitations.
Language	English
Publishing date	2024-02-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2397213-0
ISSN	1550-9397 ; 1550-9389
ISSN (online)	1550-9397
ISSN	1550-9389
DOI	10.5664/jcsm.11030
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Article ; Online: Reduced Compared With Traditional Schedules for Routine Antenatal Visits: A Systematic Review.

Balk, Ethan M / Danilack, Valery A / Bhuma, Monika Reddy / Cao, Wangnan / Adam, Gaelen P / Konnyu, Kristin J / Peahl, Alex Friedman

Obstetrics and gynecology

2023 Volume 142, Issue 1, Page(s) 8–18

Abstract: Objective: To assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules.: Data sources: A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ... ...

Abstract	Objective: To assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules. Data sources: A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, 2022, searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms, as well as primary study designs. The search was restricted to high-income countries. Methods of study selection: Double independent screening was done in Abstrackr for studies comparing televisits and in-person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. Data were extracted into SRDRplus with review by a second researcher. Tabulation, integration, and results: Five randomized controlled trials and five nonrandomized comparative studies compared reduced routine antenatal visit schedules with traditional schedules. Studies did not find differences between schedules in gestational age at birth, likelihood of being small for gestational age, likelihood of a low Apgar score, likelihood of neonatal intensive care unit admission, maternal anxiety, likelihood of preterm birth, and likelihood of low birth weight. There was insufficient evidence for numerous prioritized outcomes of interest, including completion of the American College of Obstetricians and Gynecologists-recommended services and patient experience measures. Conclusion: The evidence base is limited and heterogeneous and allowed few specific conclusions. Reported outcomes included, for the most part, standard birth outcomes that do not have strong plausible biological connection to structural aspects of antenatal care. The evidence did not find negative effects of reduced routine antenatal visit schedules, which may support implementation of fewer routine antenatal visits. However, to enhance confidence in this conclusion, future research is needed, particularly research that includes outcomes of most importance and relevance to changing antenatal care visits. Systematic review registration: PROSPERO, CRD42021272287.
MeSH term(s)	Female ; Humans ; Infant, Newborn ; Pregnancy ; Infant, Low Birth Weight ; Obstetrics ; Parturition ; Premature Birth ; Prenatal Care/methods
Language	English
Publishing date	2023-06-07
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000005193
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Article ; Online: Televisits Compared With In-Person Visits for Routine Antenatal Care: A Systematic Review.

Balk, Ethan M / Danilack, Valery A / Cao, Wangnan / Bhuma, Monika Reddy / Adam, Gaelen P / Konnyu, Kristin J / Peahl, Alex Friedman

Obstetrics and gynecology

2023 Volume 142, Issue 1, Page(s) 19–29

Abstract: Objective: To compare benefits and harms of televisits and in-person visits in people receiving routine antenatal care.: Data sources: A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, ... ...

Abstract	Objective: To compare benefits and harms of televisits and in-person visits in people receiving routine antenatal care. Data sources: A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, 2022, for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms, as well as primary study designs. The search was restricted to high-income countries. Methods of study selection: Double independent screening was done in Abstrackr for studies comparing televisits and in-person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. Data were extracted into SRDRplus with review by a second researcher. Tabulation, integration, and results: Two randomized controlled trials, four nonrandomized comparative studies, and one survey compared visit types between 2004 and 2020, three of which were conducted during the coronavirus disease 2019 (COVID-19) pandemic. Number, timing, and mode of televisits and who provided care varied across studies. Low-strength evidence from studies comparing hybrid (televisits and in-person visits) and all in-person visits did not indicate differences in rates of neonatal intensive care unit admission of the newborn (summary odds ratio [OR] 1.02, 95% CI 0.82-1.28) or preterm births (summary OR 0.93, 95% CI 0.84-1.03). However, the studies with stronger, although still statistically nonsignificant, associations between use of hybrid visits and preterm birth compared the COVID-19 pandemic and prepandemic eras, confounding the association. There is low-strength evidence that satisfaction with overall antenatal care was greater in people who were pregnant and receiving hybrid visits. Other outcomes were sparsely reported. Conclusion: People who are pregnant may prefer hybrid televisits and in-person visits. Although there is no evidence of differences in clinical outcomes between hybrid visits and in-person visits, the evidence is insufficient to evaluate most outcomes. Systematic review registration: PROSPERO, CRD42021272287.
MeSH term(s)	Female ; Humans ; Infant, Newborn ; Pregnancy ; COVID-19 ; Obstetrics ; Pandemics ; Premature Birth ; Prenatal Care/methods
Language	English
Publishing date	2023-06-07
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000005194
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Article ; Online: Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis : A Systematic Review.

Balk, Ethan M / Adam, Gaelen P / Bhuma, Monika Reddy / Konnyu, Kristin J / Saldanha, Ian J / Beland, Michael D / Shah, Nishit

Annals of internal medicine

2022 Volume 175, Issue 3, Page(s) 379–387

Abstract: Background: Clinicians need to better understand the value of computed tomography (CT) imaging and nonsurgical treatment options to manage acute left-sided colonic diverticulitis.: Purpose: To evaluate CT imaging, outpatient treatment of ... ...

Abstract	Background: Clinicians need to better understand the value of computed tomography (CT) imaging and nonsurgical treatment options to manage acute left-sided colonic diverticulitis. Purpose: To evaluate CT imaging, outpatient treatment of uncomplicated diverticulitis, antibiotic treatment, and interventional radiology for patients with complicated diverticulitis. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, CINAHL, and ClinicalTrials.gov from 1 January 1990 through 16 November 2020. Study selection: Existing systematic reviews of CT imaging accuracy, as well as randomized trials and adjusted nonrandomized comparative studies reporting clinical or patient-centered outcomes. Data extraction: 6 researchers extracted study data and risk of bias, which were verified by an independent researcher. The team assessed strength of evidence across studies. Data synthesis: Based on moderate-strength evidence, CT imaging is highly accurate for diagnosing acute diverticulitis. For patients with uncomplicated acute diverticulitis, 6 studies provide low-strength evidence that initial outpatient and inpatient management have similar risks for recurrence or elective surgery, but they provide insufficient evidence regarding other outcomes. Also, for patients with uncomplicated acute diverticulitis, 5 studies comparing antibiotics versus no antibiotics provide low-strength evidence that does not support differences in risks for treatment failure, elective surgery, recurrence, posttreatment complications, and other outcomes. Evidence is insufficient to determine choice of antibiotic regimen (7 studies) or effect of percutaneous drainage (2 studies). Limitations: The evidence base is mostly of low strength. Studies did not adequately assess heterogeneity of treatment effect. Conclusion: Computed tomography imaging is accurate for diagnosing acute diverticulitis. For patients with uncomplicated diverticulitis, no differences in outcomes were found between outpatient and inpatient care. Avoidance of antibiotics for uncomplicated acute diverticulitis may be safe for most patients. The evidence is too sparse for other evaluated questions. Primary funding source: Agency for Healthcare Research and Quality and American College of Physicians. (PROSPERO: CRD42020151246).
MeSH term(s)	Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Diagnostic Imaging ; Diverticulitis/drug therapy ; Diverticulitis, Colonic/complications ; Diverticulitis, Colonic/diagnostic imaging ; Diverticulitis, Colonic/therapy ; Humans
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-01-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; Systematic Review
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M21-1645
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Article ; Online: Rehabilitation for Total Hip Arthroplasty: A Systematic Review.

Konnyu, Kristin J / Pinto, Dan / Cao, Wangnan / Aaron, Roy K / Panagiotou, Orestis A / Bhuma, Monika Reddy / Adam, Gaelen P / Balk, Ethan M / Thoma, Louise M

American journal of physical medicine & rehabilitation

2022 Volume 102, Issue 1, Page(s) 11–18

Abstract: Abstract: We sought to determine the comparative benefits and harms of rehabilitation interventions for patients who have undergone elective, unilateral THA surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane ... ...

Abstract	Abstract: We sought to determine the comparative benefits and harms of rehabilitation interventions for patients who have undergone elective, unilateral THA surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We included randomized controlled trials and adequately adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence. Large heterogeneity across evaluated rehabilitation programs limited conclusions. Evidence from 15 studies suggests that diverse rehabilitation programs may not differ in terms of risk of harm or outcomes of pain, strength, activities of daily living, or quality of life (all low strength of evidence). Evidence is insufficient for other outcomes. In conclusion, no differences in outcomes were found between different rehabilitation programs after THA. Further evidence is needed to inform decisions on what attributes of rehabilitation programs are most effective for various outcomes.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Hip ; Quality of Life ; Activities of Daily Living ; Program Evaluation
Language	English
Publishing date	2022-03-12
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	219390-5
ISSN	1537-7385 ; 0002-9491 ; 0894-9115
ISSN (online)	1537-7385
ISSN	0002-9491 ; 0894-9115
DOI	10.1097/PHM.0000000000002007
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Article ; Online: Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review.

Konnyu, Kristin J / Thoma, Louise M / Cao, Wangnan / Aaron, Roy K / Panagiotou, Orestis A / Bhuma, Monika Reddy / Adam, Gaelen P / Pinto, Dan / Balk, Ethan M

American journal of physical medicine & rehabilitation

2022 Volume 102, Issue 1, Page(s) 1–10

Abstract: Abstract: We sought to systematically review the evidence on the benefits and harms of prehabilitation interventions for patients who are scheduled to undergo elective, unilateral total knee arthroplasty or total hip arthroplasty surgery for the ... ...

Abstract	Abstract: We sought to systematically review the evidence on the benefits and harms of prehabilitation interventions for patients who are scheduled to undergo elective, unilateral total knee arthroplasty or total hip arthroplasty surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We selected for inclusion randomized controlled trials and adequately adjusted nonrandomized comparative studies of prehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence. While large heterogeneity across evaluated prehabilitation programs limited strong conclusions, evidence from 13 total knee arthroplasty randomized controlled trials suggest that prehabilitation may result in increased strength and reduced length of stay and may not lead to increased harms but may be comparable in terms of pain, range of motion, and activities of daily living (all low strength of evidence). There was no evidence or insufficient evidence for all other outcomes after total knee arthroplasty. Although there were six total hip arthroplasty randomized controlled trials, there was no evidence or insufficient evidence for all total hip arthroplasty outcomes.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Hip/rehabilitation ; Preoperative Exercise ; Activities of Daily Living ; Arthroplasty, Replacement, Knee/rehabilitation ; Knee Joint
Language	English
Publishing date	2022-03-12
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	219390-5
ISSN	1537-7385 ; 0002-9491 ; 0894-9115
ISSN (online)	1537-7385
ISSN	0002-9491 ; 0894-9115
DOI	10.1097/PHM.0000000000002006
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Article ; Online: Rehabilitation for Total Knee Arthroplasty: A Systematic Review.

Konnyu, Kristin J / Thoma, Louise M / Cao, Wangnan / Aaron, Roy K / Panagiotou, Orestis A / Bhuma, Monika Reddy / Adam, Gaelen P / Balk, Ethan M / Pinto, Dan

American journal of physical medicine & rehabilitation

2022 Volume 102, Issue 1, Page(s) 19–33

Abstract: Abstract: We sought to determine the comparative benefit and harm of rehabilitation interventions for patients who have undergone elective, unilateral total knee arthroplasty for the treatment of primary osteoarthritis. We searched PubMed, Embase, The ... ...

Abstract	Abstract: We sought to determine the comparative benefit and harm of rehabilitation interventions for patients who have undergone elective, unilateral total knee arthroplasty for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We included randomized controlled trials and adequately adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. The team assessed strength of evidence. Evidence from 53 studies randomized controlled trials suggests that various rehabilitation programs after total knee arthroplasty may lead to comparable improvements in pain, range of motion, and activities of daily living. Rehabilitation in the acute phase may lead to increased strength but result in similar strength when delivered in the postacute phase. No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period after total knee arthroplasty; risk of harms among various postacute rehabilitation programs seems comparable. All findings were of low strength of evidence. Evaluation of rehabilitation after total knee arthroplasty needs a systematic overhaul to sufficiently guide future practice or research including the use of standardized intervention components and core outcomes.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee/rehabilitation ; Activities of Daily Living ; Range of Motion, Articular
Language	English
Publishing date	2022-03-12
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	219390-5
ISSN	1537-7385 ; 0002-9491 ; 0894-9115
ISSN (online)	1537-7385
ISSN	0002-9491 ; 0894-9115
DOI	10.1097/PHM.0000000000002008
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Article: Implant-based versus Autologous Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis.

Broyles, Justin M / Balk, Ethan M / Adam, Gaelen P / Cao, Wangnan / Bhuma, Monika Reddy / Mehta, Shivani / Dominici, Laura S / Pusic, Andrea L / Saldanha, Ian J

Plastic and reconstructive surgery. Global open

2022 Volume 10, Issue 3, Page(s) e4180

Abstract: For women undergoing breast reconstruction after mastectomy, the comparative benefits and harms of implant-based reconstruction (IBR) and autologous reconstruction (AR) are not well known. We performed a systematic review with meta-analysis of IBR versus ...

Abstract	For women undergoing breast reconstruction after mastectomy, the comparative benefits and harms of implant-based reconstruction (IBR) and autologous reconstruction (AR) are not well known. We performed a systematic review with meta-analysis of IBR versus AR after mastectomy for breast cancer. Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, and ClinicalTrials.gov for studies from inception to March 23, 2021. We assessed the risk of bias of individual studies and strength of evidence (SoE) of our findings using standard methods. Results: We screened 15,936 citations and included 40 studies (two randomized controlled trials and 38 adjusted nonrandomized comparative studies). Compared with patients who undergo IBR, those who undergo AR experience clinically significant better sexual well-being [summary adjusted mean difference (adjMD) 5.8, 95% CI 3.4-8.2; three studies] and satisfaction with breasts (summary adjMD 8.1, 95% CI 6.1-10.1; three studies) (moderate SoE for both outcomes). AR was associated with a greater risk of venous thromboembolism (moderate SoE), but IBR was associated with a greater risk of reconstructive failure (moderate SoE) and seroma (low SoE) in long-term follow-up (1.5-4 years). Other outcomes were comparable between groups, or the evidence was insufficient to merit conclusions. Conclusions: Most evidence regarding IBR versus AR is of low or moderate SoE. AR is probably associated with better sexual well-being and satisfaction with breasts and lower risks of seroma and long-term reconstructive failure but a higher risk of thromboembolic events. New high-quality research is needed to address the important research gaps.
Language	English
Publishing date	2022-03-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000004180
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 7091: Show issues

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Article: Autologous Reconstruction after Mastectomy for Breast Cancer.

Saldanha, Ian J / Broyles, Justin M / Adam, Gaelen P / Cao, Wangnan / Bhuma, Monika Reddy / Mehta, Shivani / Pusic, Andrea L / Dominici, Laura S / Balk, Ethan M

Plastic and reconstructive surgery. Global open

2022 Volume 10, Issue 3, Page(s) e4181

Abstract: Background: Women undergoing autologous reconstruction (AR) after mastectomy for breast cancer and their surgeons must make decisions regarding timing of the AR and choose among various flap types. We conducted a systematic review to evaluate the ... ...

Abstract	Background: Women undergoing autologous reconstruction (AR) after mastectomy for breast cancer and their surgeons must make decisions regarding timing of the AR and choose among various flap types. We conducted a systematic review to evaluate the comparative benefits and harms of (1) timing of AR relative to chemotherapy and radiation therapy, and (2) various flap types for AR. Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, and ClinicalTrials.gov for studies, from inception to March 23, 2021, without language restriction. We assessed risk of bias of individual studies and strength of evidence (SoE) of our findings using standard methods. Results: We screened 15,936 citations. Twelve mostly high risk of bias studies, including three randomized controlled trials and nine nonrandomized comparative studies met criteria (total N = 31,833 patients). No studies addressed timing of AR relative to chemotherapy or radiation therapy. Six flap types were compared, but conclusions were feasible for only the comparison between transverse rectus abdominus myocutaneous (TRAM) and deep inferior epigastric perforator (DIEP) flaps. The choice of either flap may result in comparable patient satisfaction with breasts and comparable risk of necrosis (low SoE for both outcomes), but TRAM flaps probably pose a greater risk of harm to the area of flap harvest (abdominal bulge/hernia and need for surgical repair) (moderate SoE). Conclusions: Evidence regarding details for AR is mostly of low SoE. New high-quality research among diverse populations of women is needed for the issue of timing of AR and for comparisons among flap types.
Language	English
Publishing date	2022-03-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000004181
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Zs.A 7091: Show issues

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Article: Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis.

Saldanha, Ian J / Broyles, Justin M / Adam, Gaelen P / Cao, Wangnan / Bhuma, Monika Reddy / Mehta, Shivani / Pusic, Andrea L / Dominici, Laura S / Balk, Ethan M

Plastic and reconstructive surgery. Global open

2022 Volume 10, Issue 3, Page(s) e4179

Abstract: Women undergoing implant-based reconstruction (IBR) after mastectomy for breast cancer have numerous options, including timing of IBR relative to radiation and chemotherapy, implant materials, anatomic planes, and use of human acellular dermal matrices. ... ...

Abstract	Women undergoing implant-based reconstruction (IBR) after mastectomy for breast cancer have numerous options, including timing of IBR relative to radiation and chemotherapy, implant materials, anatomic planes, and use of human acellular dermal matrices. We conducted a systematic review to evaluate these options. Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, and ClinicalTrials.gov for studies, from inception to March 23, 2021, without language restriction. We assessed risk of bias and strength of evidence (SoE) using standard methods. Results: We screened 15,936 citations. Thirty-six mostly high or moderate risk of bias studies (48,419 patients) met criteria. Timing of IBR before or after radiation may result in comparable physical, psychosocial, and sexual well-being, and satisfaction with breasts (all low SoE), and probably comparable risks of implant failure/loss or explantation (moderate SoE). No studies addressed timing relative to chemotherapy. Silicone and saline implants may result in clinically comparable satisfaction with breasts (low SoE). Whether the implant is in the prepectoral or total submuscular plane may not impact risk of infections (low SoE). Acellular dermal matrix use probably increases the risk of implant failure/loss or need for explant surgery (moderate SoE) and may increase the risk of infections (low SoE). Risks of seroma and unplanned repeat surgeries for revision are probably comparable (moderate SoE), and risk of necrosis may be comparable with or without human acellular dermal matrices (low SoE). Conclusions: Evidence regarding IBR options is mostly of low SoE. New high-quality research is needed, especially for timing, implant materials, and anatomic planes of implant placement.
Language	English
Publishing date	2022-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000004179
Database	MEDical Literature Analysis and Retrieval System OnLINE

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

Order via subito