ObjectiveTo systematically review the efficacy and safety of operative treatment versus nonoperative treatment in patients with adult spinal deformity (ASD).MethodsPubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang Data, and CQVIP databases were searched for controlled studies about operative treatment versus nonoperative treatment for ASD published up till June 2019. ClinicalTrials.gov was searched for grey literatures informally published up till June 2019. Two reviewers independently screened literatures, extracted data, and assessed risk of bias. Meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.ResultsA total of 10 non-randomized controlled studies were included, including 1 601 patients. The pooled results indicated that the operative group was superior to the nonoperative group in ability improvement [the increment of Scoliosis Research Society-22 score: weighted mean difference (WMD)=0.70, 95% confidence interval (CI) (0.69, 0.70), P<0.000 01; the decrement of Oswestry Disability Index score: WMD=11.12, 95%CI (10.74, 11.50), P<0.000 01], pain relief [the decrement of Numeric Rating Scale score: WMD=3.25, 95%CI (3.16, 3.35), P<0.000 01], and Cobb correction [WMD=14.06°, 95%CI (13.60, 14.53)°, P<0.000 01]. The incidence of complications was higher in the operative group than that in the nonoperative group [relative risk=5.38, 95%CI (3.67, 7.88), P<0.000 01].ConclusionsSurgery shows superior efficacy on ability improvement, pain relief, and Cobb correction compared with nonoperative treatment in ASD patients, though its incidence of complications is high. Nonoperative treatment is also an effective treatment for patients with poor physical condition and intolerance to surgery. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusions.
Objective To investigate the safety, feasibility, and clinical value of applying the enhanced recovery after surgery (ERAS) protocol in laparoscopic cholecystectomy (LC) performed under a same-day surgery model. Methods Clinical data of patients undergoing LC at West China Tianfu Hospital, Sichuan University between November 2023 and December 2024 were retrospectively analyzed. Patients who voluntarily chose the same-day discharge model prior to admission were assigned to the same-day surgery group, while those who opted for multi-day hospitalization in the general ward were assigned to the general ward group. The baseline characteristics, perioperative outcomes, postoperative complications, length of stay, preoperative waiting time, total hospitalization costs, and postoperative follow-up of the two groups were analyzed. Results A total of 499 patients were included. Among them, 248 were in the same-day surgery group and 251 were in the general ward group. There were statistically significant differences in age, history of chronic cholecystitis, postoperative nausea and vomiting severity, preoperative/intraoperative analgesia, total anesthesia duration, surgical duration, intraoperative blood loss, Visual Analogue Scale scores after returning to the ward, and postoperative nausea and vomiting incidence between the two groups (P<0.05). The same-day surgery group had significantly shorter hospitalization and preoperative waiting times, lower total hospital costs (P<0.05). Conclusions LC performed under the same-day surgery model combined with ERAS principles is safe and feasible. It conforms to the core principles of day surgery—minimal invasiveness, high efficiency, and safety—and delivers superior patients’ experience and satisfaction compared with general ward management.