Meta-Analysis of the Effects of Adhesion Barriers on Adhesion Formation in the Horse.
Abstract: To determine the efficacy of adhesion barriers in horses using quantitative statistical analysis. Methods: Meta-analytical review. Methods: A search using PubMed/MEDLINE and Google Scholar was performed, followed by secondary searches of veterinary trade journals, bibliographies of relevant articles, manufacturer websites, and technical reference guides. Randomized experimental trials in healthy horses were considered that included both a treatment and control group. The endpoint required was euthanasia or laparoscopy to identify adhesion formation. A meta-analysis was performed using a random effects model, with the effect size calculated as an odds ratio (OR) with 95% confidence intervals (CI). Statistical significance was set at P<.05. Results: Out of 354 peer reviewed publications that met the search criteria, a total of 9 relevant studies were identified and investigated the use of sodium carboxymethylcellulose (CMC) solutions, sodium hyaluronate/carboxymethylcellulose (HA/CMC) membranes, hyaluronate (HA), and fucoidan solutions. The odds of adhesions in horses treated with an adhesion barrier were significantly lower than untreated controls (OR=0.102; 95% CI [0.041, 0.254]; P<.001). When analyzed as subsets for each type of barrier, horses treated with HA/CMC membranes and CMC solutions had significant OR for fewer adhesions (OR=0.061; 95% CI [0.013, 0.292]; OR=0.119; 95% CI [0.034, 0.415], respectively; P<.001). Conclusions: The meta-analysis demonstrated adhesion barriers provide a positive effect on the odds of adhesion formation. These results are tempered by the limitations of the study, including the small sample size and a bias towards publication of studies with only positive findings.
© Copyright 2016 by The American College of Veterinary Surgeons.
Publication Date: 2016-06-15 PubMed ID: 27305446DOI: 10.1111/vsu.12494Google Scholar: Lookup
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- Journal Article
- Meta-Analysis
Summary
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The study is a meta-analysis investigating the effectiveness of adhesion barriers in horses. The results indicate that using adhesion barriers significantly reduces the occurrence of adhesions in horses compared to those untreated.
Research Methodology
- The meta-analysis was based on data sourced from various mediums including PubMed/MEDLINE and Google Scholar. Additional searches were made in veterinary trade journals, manufacturer websites, technical reference guides and bibliographies of associated articles.
- The studies included in the review were randomized experimental trials conducted in healthy horses, and each study had both a control group and treatment group. The determinant outcome was either euthanasia or laparoscopy which was used in identifying adhesion formation.
- The researchers used a random effects model for the statistical analysis. They calculated the effect size as an odds ratio (OR) with 95% confidence intervals (CI). Consideration of statistical significance was set at a P value less than .05.
Results of the Study
- From the 354 peer-reviewed articles that matched the search criteria, nine pertinent studies were taken into account. These studies explored the utilization of various barrier solutions including sodium carboxymethylcellulose (CMC) solutions, sodium hyaluronate/carboxymethylcellulose (HA/CMC) membranes, hyaluronate (HA), and fucoidan solutions.
- The researchers found that the likelihood of adhesions occurrences in horses treated with an adhesion barrier was significantly lower in comparison to untreated controls (with an OR of 0.102; 95% CI [0.041, 0.254]; P<.001).
- When the adhesion barriers were studied as subsets, horses treated with HA/CMC membranes and CMC solutions had significant OR indicating fewer adhesions (OR=0.061; 95% CI [0.013, 0.292]; OR=0.119; 95% CI [0.034, 0.415], respectively; P<.001).
Conclusions
- The meta-analysis revealed that the application of adhesion barriers positively affects the likelihood of adhesion formation in horses.
- However, these conclusions are limited by the restrictions of the study such as the small sample size and the inclination towards the publication of studies only showing positive outcomes.
Cite This Article
APA
Munsterman AS, Kottwitz JJ, Reid Hanson R.
(2016).
Meta-Analysis of the Effects of Adhesion Barriers on Adhesion Formation in the Horse.
Vet Surg, 45(5), 587-595.
https://doi.org/10.1111/vsu.12494 Publication
Researcher Affiliations
- Equine Surgery Section, Department of Clinical Sciences, Auburn University, Auburn, Alabama.
- Department of Biomedical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama.
- Equine Surgery Section, Department of Clinical Sciences, Auburn University, Auburn, Alabama.
MeSH Terms
- Animals
- Horse Diseases / prevention & control
- Horse Diseases / surgery
- Horses / surgery
- Surgical Wound Infection / prevention & control
- Surgical Wound Infection / veterinary
- Tissue Adhesions / prevention & control
- Tissue Adhesions / surgery
- Tissue Adhesions / veterinary
- Wound Healing
Citations
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