Postoperative complications of hypospadias repair in patients receiving caudal block vs. non-caudal anesthesia: A meta-analysis

  • Patrick Pine Tanseco Institute of Urology, St. Luke's Medical Center
  • Harkanwal Randhawa McMaster University, Hamilton, Ontario, Canada
  • Michael Erlano Chua St. Luke's Medical Center-Institute of Urology
  • Udi Blankstein McMaster University, Hamilton, Ontario, Canada
  • Jin Kyu Kim Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  • Melissa McGrath McMaster University, Hamilton, Ontario, Canada
  • Armando J. Lorenzo The Hospital for Sick Children, Toronto, Ontario, Canada
  • Luis H. Braga McMaster University, Hamilton, Ontario, Canada
Keywords: Caudal block, Postoperative complications

Abstract

Introduction: We performed a meta-analysis of the current literature to assess the association of caudal block and postoperative complication rates following hypospadias repair.

Methods: A Systematic literature search was conducted on October 2017. Five reviewers independently screened, identified, and evaluated comparative studies assessing postoperative outcomes following hypospadias repair with and without caudal block. The incidence of post-surgical complications from each study was extracted for caudal block and control groups to generate the odds ratio (OR) and corresponding 95% confidence intervals (CI). Effect estimates were pooled using inverse-variance method with random-effects model. Subgroup analyses were performed according to study type and hypospadias severity.

Results: Nine studies (2096patients) of low- to moderate-quality were included for meta-analysis. Overall pooled effect estimates demonstrated increased occurrence of postoperative complication rates among patients with caudal block (OR 2.32; 95% CI 1.29‒4.16). Subgroup analysis according to hypospadias severity revealed that a significant increased OR in complication rate was noted among proximal hypospadias (OR 3.55; 95% CI 1.80‒7.01), but not distal hypospadias (OR 1.31; 95% CI 0.59‒2.88).

Conclusions: Our meta-analysis of poor-quality evidence may have revealed a significant association between caudal block and postoperative complications following hypospadias repair. However, subgroup analysis demonstrated that hypospadias severity is important in determining complication rates, suggesting that confounding factors and selection bias may play a central role in characterizing the true effect of the anesthesia approach.

Author Biographies

Patrick Pine Tanseco, Institute of Urology, St. Luke's Medical Center
Institute of Urology
Michael Erlano Chua, St. Luke's Medical Center-Institute of Urology
Institute of Urology- Urologist staff
Published
2018-12-03
How to Cite
Tanseco, P. P., Randhawa, H., Chua, M. E., Blankstein, U., Kim, J. K., McGrath, M., Lorenzo, A. J., & Braga, L. H. (2018). Postoperative complications of hypospadias repair in patients receiving caudal block vs. non-caudal anesthesia: A meta-analysis. Canadian Urological Association Journal, 13(8). https://doi.org/10.5489/cuaj.5688
Section
Original Research