Is early surgery beneficial in XXXX ? A systematic review.

@entity1 @entity712 @entity733 @entity884
We do not know whether surgery during the active phase of @entity884 improves prognosis, as no randomized trial data exist. Several observational studies published recently have examined the influence of surgery on prognosis by performing a propensity score analysis. The aim of the present paper is to review these studies, in order to determine whether or not early surgery decreases mortality in adult @entity1 with @entity884 . Among nine published studies, 4199 @entity1 were included overall. The rate of surgery during the active phase of @entity884 ranged from 23 to 53%. Surgery was significantly beneficial in six studies (adjusted hazard ratios or odds ratios ranging from 0.27 to 0.47), neutral in two studies and without benefit in one study (hazard ratio 1.9; 95% confidence interval 1.1-3.2). Conflicting results appear to be related to differences in statistical methods. When using appropriate models, surgery is significantly associated with reduced long-term mortality. Results from these observational studies suggest that current surgical practices in @entity884 are beneficial in terms of long-term survival. However, we cannot conclude that surgery is beneficial and must be performed in all @entity1 with @entity884 . Surgery was associated with a favourable outcome in those @entity1 in whom @entity884 and @entity1 characteristics led the physicians to perform surgery. @entity1 who seem to benefit most from surgery are those who fulfil management guidelines (embolic event, @entity712 and/or @entity733 ).
