A Brief Guide to Performing Review and Meta-analysis of Rare Diseases, Procedures, and Other Low Frequency Pathology

Editor's Choice - Reporting and Methodological Quality of Systematic Reviews Underpinning Clinical Practice Guidelines for Vascular Surgery: A Systematic Review

OBJECTIVE

Clinical practice guideline recommendations are often informed by systematic reviews. This review aimed to appraise the reporting and methodological quality of systematic reviews informing clinical practice recommendations relevant to vascular surgery.

DATA SOURCES

MEDLINE and Embase.

METHODS

MEDLINE and Embase were searched from 1 January 2021 to 5 May 2023 for clinical practice guidelines relevant to vascular surgery. Guidelines were then screened for systematic reviews informing recommendations. The reporting and methodological quality of these systematic reviews were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) 2017 tool. Pearson correlation and multiple regression analyses were performed to determine associations between these scores and extracted study characteristics.

RESULTS

Eleven clinical practice guidelines were obtained, containing 1 783 references informing guideline recommendations. From these, 215 systematic reviews were included for synthesis. PRISMA item completeness ranged 14 - 100%, with a mean of 63% across reviews. AMSTAR 2 item completeness ranged 2 - 95%, with a mean of 50%. Pearson correlation highlighted a statistically significant association between a review's PRISMA and AMSTAR 2 score (r = 0.85, p < .001). A more recent publication year was associated with a statistically significant increase in both scores (PRISMA coefficient 1.28, p < .001; and AMSTAR 2 coefficient 1.31, p < .001). Similarly, the presence of funding in a systematic review was shown to be statistically significantly associated with an increase in both PRISMA and AMSTAR 2 scores (coefficient 4.93, p = .024; and coefficient 6.07, p = .019, respectively).

CONCLUSION

Systematic reviews informing clinical practice guidelines relevant to vascular surgery were of moderate quality at best. Organisations producing clinical practice guidelines should consider funding systematic reviews to improve the quality of their recommendations.

Infective native visceral artery aneurysm (INVAA): A systematic review of etiology, treatment, and outcomes

The present review introduces the term 'infective native visceral artery aneurysm (INVAA)' and provides a systematic review of the literature on this topic. The terms 'mycotic' and 'infected' have been replaced by the term 'infective native' to more accurately describe aneurysms of this type. A systematic search of MEDLINE, Embase, Google Scholar, and Scopus databases was performed to identify articles reporting on INVAAs to April 2024. Inclusion criteria encompassed studies describing 'mycotic' or 'infected' primary visceral aneurysms, excluding patients with concurrent aneurysms in the aorta. The search yielded 356 articles, with 161 meeting the inclusion criteria, covering 175 patients. The median age was 48 years (IQR: 33-60 years), predominantly men (n = 127, 72.6%). INVAA was most frequently reported in the superior mesenteric artery (37.5%, n = 65), followed by the hepatic (22.9%, n = 40) and splenic arteries (14.3%, n = 25). Endocarditis was the predominant etiology in 67.4% (n = 118) of cases. Gram-positive pathogens were identified in 58.8% (n = 103) of cases. Treatment modalities included open surgery (49.7%, n = 87), endovascular interventions (37.7%, n = 66), and medical management (12.0%, n = 21). The overall proportion of patients who died was 13.7% (n = 24). In multivariable modeling, cerebral aneurysms (OR: 4.0, 95% CI 1.17, 12.8; p = 0.02), gastrointestinal bleed (OR: 5.79, 95% CI 1.86, 17.6; p < 0.01), and chronic kidney disease (OR: 16.0, 95% CI 2.3, 136; p < 0.01) were associated with increased odds of death. The optimal treatment for INVAA remains undefined, highlighting the need for standardization of reporting and prospective registries to enhance the understanding and management of this complex disease.