Meta-Analysis of Open vs Closed Surgery of Mandibular Condyle Fractures

A review of the literature reveals a difference of opinion regarding whether open or closed reduction of condylar fractures produces the best results. It would be beneficial to critically analyze past studies that have directly compared the two methods in an attempt to answer this question. A Medline search for articles using the key words \u27mandibular condyle fractures\u27 and \u27mandibular condyle fractures surgery\u27 was performed. The articles chosen for the meta-analysis contained data on at least one of the following: postoperative maximum mouth opening, lateral excursion, protrusion, deviation on opening, asymmetry, and joint pain or muscle pain. Several common statistical methods were used to test for differences between open and closed surgery, including the weighted average method for fixed and random effects as well as the Mantel-Haenszel method for fixed effects. Some of the outcome variables were found to be statistically significant but were interpreted with caution because of the poor quality of the studies assessed. There is a need for more standardized data collection as well as patient randomization to treatment groups

Quality improvement program decreases mortality after cardiac surgery

ObjectiveThis study investigated the effects of a quality improvement program and goal-oriented, multidisciplinary protocols on mortality after cardiac surgery.MethodsPatients were divided into two groups: those undergoing surgery (coronary artery bypass grafting, isolated valve surgery, or coronary artery bypass grafting and valve surgery) after establishment of the multidisciplinary quality improvement program (January 2005–December 2006, n = 922) and those undergoing surgery before institution of the program (January 2002–December 2003, n = 1289). Logistic regression and propensity score analysis were used to adjust for imbalances in patients' preoperative characteristics.ResultsOperative mortality was lower in the quality improvement group (2.6% vs 5.0%, P < .01). Unadjusted odds ratio was 0.5 (95% confidence interval 0.3–0.8, P < .01); propensity score–adjusted odds ratio was 0.6 (95% confidence interval 0.4–0.99, P = .04). In multivariable analysis, diabetes (P < .01), chronic renal insufficiency (P = .05), previous cardiovascular operation (P = .04), congestive heart failure (P < .01), unstable angina (P < .01), age older than 75 years (P < .01), prolonged pump time (P < .01), and prolonged operation (P = .05) emerged as independent predictors of higher mortality after cardiac surgery, whereas quality improvement program (P < .01) and male sex (P = .03) were associated with lower mortality. Mortality decline was less pronounced in patients with than without diabetes (P = .04).ConclusionApplication of goal-directed, multidisciplinary protocols and a quality improvement program were associated with lower mortality after cardiac surgery. This decline was less prominent in patients with diabetes, and focused quality improvement protocols may be required for this subset of patients