Recurrence rates of video-assisted thoracoscopic versus open surgery in the prevention of recurrent pneumothoraces: a systematic review of randomised and non-randomised trials Barker A, Maratos E C, Edmonds L, Lim E CRD summary This review compared the efficacy of video-assisted and open surgery for the prevention of recurrent pneumothorax. The authors concluded that the video-assisted approach was associated with a four-fold higher rate of recurrent pneumothorax. This review was well-conducted and the conclusions appear reliable. Authors' objectives To compare the efficacy of video-assisted and open surgery for the prevention of recurrent pneumothorax. Searching MEDLINE (1950 to October 2006), EMBASE (1974 to October 2006), and the Cochrane Library (Issue 4, 2006) were searched; the search terms were reported. No language restrictions were applied. To identify additional studies, trial registers on the Internet and abstracts from major cardiothoracic surgery scientific meetings were searched (2004 to 2006) and reference lists of all relevant studies were screened. Study selection Study designs of evaluations included in the review Randomised and non-randomised studies were eligible for inclusion. Specific interventions included in the review Studies that compared video-assisted thoracoscopic surgery with open surgery were eligible for inclusion. Where reported, the surgical procedure consisted of (limited) pleurectomy and/or pleural abrasion in all but one of the included studies; this study compared the video-assisted approach with bilobectomy. Participants included in the review Studies of patients undergoing surgery for pneumothorax were eligible for inclusion. When reported, the patients' mean age ranged from 20 to 45 years and the proportion of males from 58 to 97%. Outcomes assessed in the review Studies that provided data on recurrence rates were eligible for inclusion. Where reported, follow-up ranged from 24 days to 4,961 days. The outcomes assessed by the review were recurrence rates, post-operative pain and duration of hospital stay. How were decisions on the relevance of primary studies made? At least two independent reviewers selected the studies, with any disagreements resolved by consensus. If the same population was evaluated in more than one article, the report with the most complete follow-up was selected. Assessment of study quality Study quality was assessed using the Downs and Black quality scale, which assigns one point for each of 27 criteria. The authors did not state how many reviewers performed the validity assessment. Data extraction The authors did not state how many reviewers performed the data extraction. For studies in which there was more than one open surgery group, the data were extracted as a single comparison group by pooling data from each of the groups. Results data were extracted as whole numbers rather than percentages. Relative risks (RRs) of recurrence in patients undergoing thorascopic surgery compared with those having open surgery were calculated. Methods of synthesis Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2018 University of York Page: 1 / 3